药物洗脱支架植入术后患者联合使用氯吡格雷和质子泵抑制剂的临床观察  

Clinical outcomes in patients with the concomitant use of clopidogrel and proton pump inhibitors after received drug-eluting stent implantation

作　　者：郭予洁[1] 韦金儒[2] 银剑斌[1] 

机构地区：[1]广西医科大学第五附属医院(柳州市人民医院)心血管内科,广西南宁5345006 [2]广西医科大学附属南宁市第一人民医院,广西南宁530022

出　　处：《中国现代医学杂志》2013年第25期51-55,共5页China Journal of Modern Medicine

基　　金：广西卫生厅基金资助项目(No:Z2008419)

摘　　要：目的探讨规范使用氯比格雷的药物洗脱支架(Drug-eluting stent,DES)植入术后患者是否合用质子泵抑制剂(Proton pump inhibitors,PPI)对患者心血管不良事件(Major adverse cardiac events,MACEs)发生率的影响。方法纳入2004年1月～2010年5月在该院置入药物洗脱支架的病人1 207例,术后规范长期服用氯比格雷12月+阿司匹林片100 mg长期,以未服用PPI之患者为对照组,按照PPI服用时间分组,记录各组患者基础、临床、介入治疗情况及临床随访结果,实际随访例数为1 154例(共植入支架1 451枚),随访时间由12～68个月不等,平均随访时间为51个月。失访率为4.4%。结果①服用PPI 6个月以上组MACEs发生率高于其他组,该组患者发生MACE事件的风险率高于其他组,差异有显著性,其余不同时间PPI之患者心血管不良反应发生率与未服用相比略高,但无显著性;②各种类型的PPIs与MACEs发生无必然联系;③不同的洗脱涂层支架置入术后服用PPIs后MACEs事件的发生率差异无显著性。结论规范服用双联抗血小板治疗的置入药物洗脱支架患者长期服用PPI可能导致MACE事件发生率增加。[ Objective ] To evaluate whether the PPIs and clopidogrel was associated with worse clinical outcomes after received Drug-eluting stent implantation compared with the clopidogre] alone. [Methods] From Jan 2004 to May 2009, a total of 1 207 consecutive patients with CAD received drug-eluting stent implantation in our hospital. All patients received aspirin indefinitely and a thienopyridine for 1 to 12 months. Patients were categorized into dif- ferent groups according to the time of PPIs, the patients without PPIs were used as the control group. Major adverse cardiac events （MACE） including cardiac death, non-fatal myocardialin fraction, heart fail or target vessel revaseularization in Clinical follow-up after initial procedure were compared between different groups. [ Results ] ① Mean follow-up duration was 51 months after stent implanting. Rate of MACE occurrence in the group of Appling asprin and Clopidogrel and PPIs over 6 months （11.6%） were much higher than other groups, there was significant difference among these groups （P 〈0.05）, and after adjustment for baseline difference, PPIs use was associated with a higher incidence of Maces （HR, 1.252; 95% CI, 0.987N2.121, P =0.041）. ②Different types of PPI use were not associated with an increased risk of MACE occurrence in patients administered elopldogrel after Drug-eluting stenl implanting. ③Rale of MACEs occurrence in groups of Different type Drug-elnting stents was no statistical difference among these groups, [ Conclusions ] The long-term use of PPIs with dual antiplatelet therapy after Drug-e- 6 months, may encrease the Rate of MACE occurrenee.

关 键 词：氯吡格雷 质子泵抑制剂 药物洗脱支架 主要心血管不良事件 

分 类 号：R541[医药卫生—心血管疾病]