Antibiotic trials for coronary heart disease.
Antibiotic trials for coronary heart disease.
复制标题
冠心病的抗生素试验。
DOI：
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发表时间：
2004
影响因子：
0.9
通讯作者：
J. Muhlestein
中科院分区：
文献类型：
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作者：
Jeffrey L. Anderson;J. Muhlestein
近年来，有一种可能性被提出，即感染可能是慢性“非传染性”退行性疾病的炎性刺激因素。在过去的十年里，细菌载体作为动脉粥样硬化的致病因素的可能性受到了严重的关注。到目前为止，最多的信息与细胞内的肺炎衣原体有关。在人类动脉粥样硬化斑块中，经常发现细菌抗原，有时还发现可恢复的生物体，这激发了人们的兴趣。支持和反对抗衣原体抗生素的益处的间接证据来自流行病学研究。鉴于观察性研究中存在混淆的可能性，需要进行前瞻性、随机化干预试验。这些抗生素试验为证明(或反驳)动脉粥样硬化的传染病假说和建立新的治疗方法产生了热情的期望。然而，这些预期受到了重要限制和不确定性的影响。负面结果不仅可以由不正确的假设解释，也可以由研究规模或设计不足或无效的抗生素方案解释。相反，如果研究是肯定的，这一假设仍然没有完全得到证实，因为对其他生物的非特异性抗炎作用或抗感染作用可能是有效的。到目前为止的临床试验数据还没有为抗生素在冠心病一级或二级预防中的临床使用提供足够的支持。除了传统设计的抗生素试验之外，新的和创新的实验方法应该受到欢迎，因为我们试图充分了解感染在动脉粥样硬化及其治疗中的作用。
The possibility has been raised in recent years that infection might contribute as an inflammatory stimulus to chronic "noninfectious" degenerative diseases. Within the past decade, serious attention has been given to the possibility of bacterial vectors as causal factors of atherosclerosis. To date, the greatest amount of information has related to the intracellular organism Chlamydia pneumoniae. This interest has been stimulated by the frequent finding of bacterial antigens and, occasionally, recoverable organisms, within human atherosclerotic plaque. Indirect evidence for and against the benefit of anti-Chlamydia antibiotic agents comes from epidemiologic studies. Given the potential for confounding in observational studies, prospective, randomized intervention trials are required. These antibiotic trials have generated enthusiastic expectations for proving (or disproving) the infectious-disease hypothesis of atherosclerosis and establishing new therapies. However, these expectations have been tempered by important limitations and uncertainties. Negative outcomes can be explained not only by an incorrect hypothesis but also by inadequate study size or design or by an ineffective antibiotic regimen. In contrast, if studies are positive, the hypothesis still is not entirely proved, because a nonspecific anti-inflammatory effect or an anti-infective action against other organisms might be operative. The clinical trial data to date have not provided adequate support for the clinical use of antibiotics in primary or secondary prevention of coronary heart disease. New and innovative experimental approaches, in addition to traditionally designed antibiotic trials, should be welcome in our attempts to gain adequate insight into the role of infection in atherosclerosis and its therapy.