不同质子泵抑制剂对PCI术后氯吡格雷抗血小板临床效果的影响  

Effect of different proton pump inhibitors on the clinical antiplatelet effects of clopidogrel for patients undergone percutaneous coronary intervention

作　　者：蔡军[1] 武强[1] 孙静[1] 龙梅[1] 刘长福[2] 

机构地区：[1]解放军总医院国际医学中心,北京100853 [2]解放军总医院心内科,北京100853

出　　处：《解放军医学杂志》2010年第12期1481-1483,共3页Medical Journal of Chinese People's Liberation Army

基　　金：军队保健专项项目(07BJZ01)

摘　　要：目的探讨不同机制的质子泵抑制剂对冠脉介入治疗(PCI)术后氯吡格雷抗血小板临床效果的影响。方法选择2008年10月-2009年9月在解放军总医院实施PCI术后氯吡格雷联合阿司匹林抗血小板治疗(氯吡格雷75mg/d+阿司匹林100mg/d)的患者406例。将患者随机分为奥美拉唑组(40mg/d,146例)、泮托拉唑组(40mg/d,140例)和对照组(未服用质子泵抑制剂,120例),连续用药30d。观察比较各组主要不良心血管事件(心源性死亡、非致死性急性心肌梗死、紧急靶血管血运重建、亚急性支架内血栓、脑卒中)发生率和出血并发症发生情况。结果三组的临床基本资料、冠脉造影及PCI结果无统计学差异。奥美拉唑组的心源性死亡、非致死性急性心肌梗死、紧急靶血管血运重建、亚急性支架内血栓、脑卒中的发生率分别为0.70%、2.11%、3.52%、1.41%、0.70%;泮托拉唑组分别为0.72%、2.90%、2.90%、0.72%、0.72%,对照组分别为0.83%、1.66%、3.33%、1.66%、0.83%,三组主要不良心血管事件发生率相近,差异无统计学意义(P>0.05)。与对照组(10.83%)比较,奥美拉唑组和泮托拉唑组出血发生率(分别为6.33%、6.52%)均明显减少,差异有统计学意义(P<0.01),但两组之间的出血发生率差异无统计学意义(P>0.05)。结论奥美拉唑和泮托拉唑作用相近,不降低冠脉支架植入术后氯吡格雷联合抗血小板治疗对心血管事件的预防效果,同时可明显降低患者出血事件发生率。Objective To investigate the effect of different proton pump inhibitors on the clinical antiplatelet effect clopidogrel in patients undergone percutaneous coronary intervention（PCI）.Methods From Oct.2008to Sep.2009,a tota1of 406patients admitted to the General Hospital of PLA were enrolled in the present study,and they received clopidogrel（75mg/d）and aspirin（100mg/d）after undergoing PCI.The subjects were randomly assigned to three groups：omeprazole group（receiving 40mg/d of Omeprazole for 30days, n=146）,pantoprazole group（receiving 40mg/d of Pantoprazole for 30days,n=140）and control group（receiving no proton pump inhibitor,n=120）.The incidence of major adverse cardiac and cerebral events（MACCE）,including cardiac death,non-fatal myocardial infarction（MI）,urgent target vessel revascularization（UTVR）,sub-acute in-stent thrombosis（SAT）and stroke,and hemorrhagic complications were observed and compared among the three groups.Results No significant difference existed among the three groups in baseline data,angiography and PCI result.The rates of MACCE,cardiac death,MI,UTVR,SAT and stroke in omeprazole group were, 0.70%,2.11%,3.52%,1.41%and 0.70%,respectively,in pantoprazole group they were,0.72%,2.90%,2.90%,0.72%and 0.72%,respectively,and in control group they were,0.83%,1.66%,3.33%,1.66% and 0.83%,respectively.No significant difference was found among the three groups（P〉0.05）.Compared with that in control group（10.8%）,the rates of hemorrhagic complications in omeprazole group and pantoprazole group were decreased significantly（6.33%and 6.52%,respectively,P〈0.01）,but no significant difference was found between omeprazole and Pantoprazole group（P〉0.05）.Conclusions Similar to that of Pantoprazole, short-term therapy of omeprazole for the patients undergone PCI does not attenuate the clopidogrel effect of preventing MACCE,and it can reduce the incidence of hemorrhagic complications.

关 键 词：奥美拉唑 泮托拉唑 氯吡格雷 出血 心血管事件 血管成形术 经腔 经皮冠状动脉 

分 类 号：R541.4[医药卫生—心血管疾病]