泮托拉唑和雷贝拉唑对双联抗血小板治疗效应的影响  

Effects of Pantoprazole and Rabeprazole on the Effect of Antiplatelet Dual Therapy

作　　者：刘如泉[1] 文媛[1] 马继东[1] 兰为群 朱汉东[2] 

机构地区：[1]武汉市汉口医院心内科,武汉430012 [2]武汉亚洲心脏病医院心内科,武汉430022

出　　处：《医药导报》2013年第6期738-741,共4页Herald of Medicine

摘　　要：目的观察泮托拉唑和雷贝拉唑对急性冠脉综合征患者双联抗血小板治疗效应的影响。方法急性冠脉综合征患者352例,随机分为泮托拉唑组112例,3组均给予泮托拉唑40 mg·d-1,po;雷贝拉唑组119例,给予雷贝拉唑10 mg·d-1,po,对照组121例,不加用质子泵抑制药。3组均常规给予β-受体阻断药、血管紧张肽转化酶抑制药、硝酸酯类及他汀类药物治疗,并进行双联抗血小板治疗。检测用药前和用药后1个月血小板反应指数,并随访12个月,比较3组再发心血管事件和消化道不良反应的发生率。结果用药1个月后,3组血小板反应指数均较用药前明显降低(P<0.05),雷贝拉唑组与其他两组比较差异有统计学意义(P<0.05)。随访3个月表明,雷贝拉唑组再发心血管事件高于泮托拉唑组和对照组(P<0.05);随访12个月则3组的心血管事件发生差异无统计学意义(P>0.05),消化道不良反应的发生率分别为7.56%,8.93%,37.19%(P<0.05)。结论急性冠脉综合征患者在双联抗血小板治疗同时加用泮托拉唑对氯吡格雷抗血小板疗效的影响较雷贝拉唑小。Objective To investigate the influence of pantoprazole and rabeprazole on the effect of antiplatelet dual therapy in patients with acute coronary syndrome （ ACS ）. Methods Three hundred and fifty-two patients with ACS were randomly divided into pantoprazole group （40 mg · d-1, n= 112）, rabeprazole group （10 mg · d-1, n= 119） and control group （no PPI, n= 121 ）. All the patients received standard therapy including beta receptor blockers, angiotensin-converting enzyme inhibitors, nitrates, and statins. The platelet reactivity index before and 1 month after the treatment was calculated, the recurrence of cardiovascular events （CVEs） and gastrointestinal adverse reactions （GARs） after a follow-up for 12 months were investigated. Results The platelet reactivity index after 1 month treatment was significantly lower than that before the treatment in each group （P〈0.05）. There was a significant difference in platelet reactivity index between rabeprazole group and other groups after 1 month treatment （P〈0.05）. The incidence of CVEs in rabeprazole group was 13.45% , higher than that in pantoprazole group and control group after a follow-up for 3 months （P〈0.05）. There was no difference of the CVEs in each group after a follow-up for 12 months. The GARs of PPI groups were lower than that of control group after a follow-up for 3 months and 12 months （7.56% , 8.93%, 37.19% respectively, P〈0.05 ）. Conclusion The influence of PPI on the antiplatelet effect of clopidogrel in patients with ACS is less with pantoprazole than rabeprazole.

关 键 词：泮托拉唑 雷贝拉唑 氯吡格雷 血小板反应指数 心血管事件 消化道不良反应 

分 类 号：R975.2[医药卫生—药品] R973.2[医药卫生—药学]