干预急性冠状动脉综合征患者幽门螺旋杆菌感染对其预后及血炎症介质的影响  

Effects of Helicobacter Pylori Eradication on Prognosis and Serum Leves of Inflammation Substances in Acute Coronary Syndrome Patiens

作　　者：刘大男[1] 何作云[1] 刘兴德[2] 李金生[2] 方颖[2] 吴立荣[2] 李屏[2] 

机构地区：[1]第三军医大学新桥医院心内科,重庆市400037 [2]贵阳医学院附属医院心内科,贵州省贵阳市550004

出　　处：《中国动脉硬化杂志》2007年第4期299-302,共4页Chinese Journal of Arteriosclerosis

基　　金：贵州省科学基金(19991177)

摘　　要：目的探讨根除幽门螺旋杆菌治疗对急性冠状动脉综合征患者再发冠心病事件及血炎症介质的影响。方法将伴幽门螺旋杆菌感染的急性冠状动脉综合征患者随机分为对照组(n=74)和治疗组(n=82),对照组采用常规药物治疗,治疗组在常规药物治疗的基础上加用奥美拉唑(20mg,2次/天)、克拉霉素(500mg,2次/天)和阿莫西林(500mg,3次/天)口服,疗程10天。观察再发冠心病事件的发生率,并取血检测幽门螺旋杆菌IgG、超敏C反应蛋白、可溶性细胞间粘附分子1和白细胞介素6。结果随访12个月,再发冠心病事件的发生率治疗组为6.76%,对照组为14.63%,治疗组相对危险降低53.79%(P=0.0193),其中非致死性急性心肌梗死治疗组为5.41%,对照组为15.85%,治疗组相对危险降低65.87%(P=0.0387);其他事件的发生率治疗组为14.86%,对照组为39.02%,治疗组相对危险降低61.92%(P=0.005),其中治疗组因心绞痛入院的为8.11%,对照组为20.73%,治疗组相对危险降低60.88%(P=0.0269),冠状动脉支架植入术和旁路移植术在治疗组为4.05%,对照组为14.63%,治疗组相对危险降低72.35%(P=0.0252)。与治疗前及对照组相同时间点比较,治疗组治疗后幽门螺旋杆菌IgG、血超敏C反应蛋白、可溶性细胞间粘附分子1及白细胞介素6水平显著降低(P<0.01或P<0.05)。结论根除幽门螺旋杆菌治疗可降低非致死性急性心肌梗死的发生率、因心绞痛入院率,减少对冠状动脉支架植入术和旁路移植术的需求,并降低血炎症介质水平,表明根除幽门螺旋杆菌感染治疗在冠心病二级预防中起有益作用。Aim To evaluate the effects of Helicobacter pylofi （Hp） eradication on coronary events and the serum levels of inflammation substances in acute coronary syndrome patiens. Methods 46 Unstable angina patiens and 110 acute myocardial infarction patiens with evidence of Hp infection were randomized into control group （ n = 82 ） and treatment group （ n = 74 ）. Treatment group were treated with Omeprazole, clarithromycin and amoxicillin for ten days in addition to conventional therapy （control group） were used for Hp eradication. Results The follow up period was one year. The incidence of the coronary artery events were 6.76% in treatment group and 14.63% in control group, with a reduction of relative risk by 48.85% for treatment group （P=0.0246）, Among them, incidence of non-fatal myocardial infarction reduced by 65.87% in treatment group compared to control group （5.41%vs15.85%, P=0.0387） ; the incidence of the other events also decreased by 61.92% in treatment group compared to control group （14.86% vs 39.02%, P = 0.005）, Among them, the demand for PCI/CABG was 4.05% in treatment group and 14.63% in control group, with a reduction of relative risk by 72.35% in treatment group （ P = 0.0252 ）, readmission with angina reduced by 60.88% in treatment group compared to control group （8.11% vs 20.73 %, P = 0.0269）. The serum levels of IgG, high sentsitivity C-reactive protein （hsCRP）, soluble intereellular adhesion molecule- 1 （sICAM-1 ） and interlettldn-6 （IL-6） in treatment group were distinctly lower than those in control group after treatment （ P 〈 0.01 or P 〈 0.05 ）. Conclusion Hp eradication can significantly decrease the incidence of nonfatal myocardial infarction and readmission with angina and the demand for PCI/CABG.

关 键 词：内科学 急性冠状动脉综合征 幽门螺旋杆菌 冠心病事件 炎症介质 二级预防 

分 类 号：R5[医药卫生—内科学]