既往胃镜检查对评估经皮冠脉介入术后非急性冠脉综合症患者是否联用质子泵抑制剂的作用  

The role of previous gastroscopy in evaluation of concomitant use of PPIs in patients with non-acute coronary syndrome after percutaneous coronary intervention

作　　者：杨肖波[1] 俞丽芬[1] 徐琛莹[1] 李薇薇[1] 孙露萤[1] 常显星[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院消化科,上海200025

出　　处：《中华消化内镜杂志》2013年第3期133-137,共5页Chinese Journal of Digestive Endoscopy

摘　　要：目的探讨经皮冠脉介入术（PCI）前非急性冠脉综合症（非ACS）患者既往胃镜检查对PCI术后综合评估联用质子泵抑制剂（PPIs）的风险和获益的重要意义。方法回顾性分析673例行PCI术放置冠脉支架的非ACS患者，先将其分为PPIs联用组和未联用组，然后根据与上消化道不良事件密切相关的危险因素再分高、中、低危亚组，分别比较各组心血管和上消化道不良事件发生率的差别以及既往胃镜检查情况。结果PCI术前5年内仅12．2％（82／673）的患者曾行胃镜检查，消化性溃疡的总体检出率为32．9％（27／82），PPIs联用组占55．6％（15／27）。PPIs联用组患者的心血管不良事件发生率显著高于未联用组（22．6％比8．9％，P〈0．01），其中以消化道高危患者（16．4％，24／146）的心血管不良事件发生率最高（41．7％，10／24），但其上消化道不良事件发生率最低（4．2％，1／24）。90．5％（344／380）的中危患者是年龄I〉65岁且联用NSAIDs等药物者，其在PCI术前5年内行胃镜检查的比例显著低于既往有上消化道病史且联用NSAIDs等药物者（PPIs联用组：14．1％比54．5％，P〈0．01；未联用组：7．5％比28．0％，P〈0．01），在PPIs联用组前者心血管不良事件发生率显著高于后者（20．5％比9．1％，P〈0．01），但两者在PCI术后1年内上消化道不良事件的发生率相近（9．0％比9．1％，P〉0．05）。结论PCI术前既往胃镜检查可提供上消化道基础疾病信息，有助于PCI术后合理应用PPIs，减少心血管不良事件的发生。年龄I〉65岁且联用NSAIDs等药物的中危患者是需重点关注的人群。Objective To evaluate previous gastroscopy before percutaneous coronary intervention （PCI） for the risks and benefits of concomitant use of proton pump inhibitors （PPIs） after PCI in patients with non-acute coronary syndrome （non-ACS）. Methods The data of 673 non-ACS patients who underwent PCI with stenting were retrospectively analyzed. They were divided into concomitant use of PPIs group and non-PPIs group, then subdivided into high-, moderate- and low-risk groups according to risk factors associat- ed with adverse upper gastrointestinal （GI） events. The incidences of adverse cardiovascular events and ad- verse upper GI events were compared among groups. Findings of previous gastroscopy were also included. Results Only 82 patients （12. 2% ） underwent gastroscopy within 5 years before PCI, of whom, 27 （32. 9% ） were diagnosed as having peptic ulcer, and 55. 6% （15/27） of whom were in concomitant use of PPIs. Compared with the non-PPIs group, the rate of adverse cardiovascular events in the concomitant useof PPIs group was significantly higher （22. 6% vs. 8. 9%, P 〈0. 01 ）, and the highest rate （41.7%） was in the high-risk group. However, the corresponding rate of adverse upper GI events was the lowest （4. 2% ）. In the moderate-risk group, 90.5% （344/380） of patients were older than 65 years with concomitant use of NSAIDs. The rate of gastroseopy within 5 years before PCI in these patients was remarkably lower than that in patients who had the history of upper GI disease with concomitant use of NSAIDs （ concomitant use of PPIs group 14. 1% vs. 54. 5% ;non-PPIs group 7. 5% vs. 28. 0% ;P 〈0. 01 ）. In the concomitant use of PPIs group, the rate of adverse cardiovascular events in the former was notably higher than that in the latter （20. 5% vs. 9. 1%, P 〈0.01 ）, but the rate of adverse upper GI events within 1 year after PCI were similar （9. 0% vs. 9. 1% ）. Conclusion Previous gastroseopy before PCI could provide the baseline information of upper GI disea

关 键 词：胃镜检查 非急性冠脉综合症 经皮冠脉介入术 质子泵抑制剂 心血管不 良事件 

分 类 号：R541.4[医药卫生—心血管疾病]