不同质子泵抑制剂对非ST段抬高型急性冠状动脉综合征患者氯吡格雷抗血小板疗效的影响  

Effect of different proton pump inhibitors on antiplatelet efficacy of clopidogrel in patients with nonST segment elevation acute coronary syndrome

作　　者：赖绍斌 邓斌[1] 苏良献[1] 赵冬华[1] 郑晓丹[1] 任惠欢 黄剑霞 

机构地区：[1]肇庆市第一人民医院心血管内科重症监护室,526040

出　　处：《中国心血管杂志》2015年第3期166-170,共5页Chinese Journal of Cardiovascular Medicine

摘　　要：目的探讨质子泵抑制剂对接受氯吡格雷抗血小板治疗的非ST段抬高型急性冠状动脉综合征(NSTE-ACS)患者疗效的影响。方法采用前瞻性研究,共纳入2012年1月至2013年6月接受冠状动脉内药物洗脱支架置入的NSTE-ACS患者145例,采取密封信封抽样形式分为A和B两组,在标准药物治疗(氯吡格雷、阿司匹林、低分子肝素、硝酸酯类、调脂药以及其他常规治疗)基础上,A组合用泮托拉唑(72例)而B组合用奥美拉唑(73例)。观察1年内患者的消化道出血事件以及主要不良心血管事件,包括全因死亡、心原性死亡、卒中、因心绞痛或心力衰竭再住院、血运重建。结果 A和B两组心血管事件发生率差异无统计学意义(均为P>0.05),其中全因死亡(6.9%比5.5%)、心原性死亡(4.2%比5.5%)、因心绞痛或心力衰竭再住院(16.6%比15.0%)和血运重建(11.1%比12.3%),消化道出血发生率差异亦无统计学意义(5.6%比5.5%,P>0.05)。结论本研究入选的NSTE-ACS患者中,两类质子泵抑制剂对氯吡格雷抗血小板疗效的影响无显著差异。Objective The study sought to compare the effect of different proton pump inhibitors（ PPI） on antiplatelet efficacy of clopidogrel in patients with non-ST segment elevation acute coronary syndrome（ NSTEACS）. Methods A prospective,randomized clinical trial was studied. One hundred and forty-five patients with NSTEACS after drug eluting stent implantation were recruited in the study. Patients were assigned into group A and B randomly,and given standard medical therapy（ clopidogrel,aspirin,low molecular weight heparin,nitrates,statins and other routine treatments）. Patients in group A（ n = 72） were treated with pantoprazole,while with omeprazole in group B（ n = 73）. We examined the one-year incidences of gastrointestinal bleedings and major adverse cardiac events（ MACE） including all cause mortality,cardiovascular death,stroke,hospitalization due to angina pectoris or heart failure,and revascularization.Results The rates of cardiovascular events between group A and B was of no significant difference（ P〉0. 05） ： all cause mortality（ 6. 9% vs. 5. 5%）; cardiovascular death（ 4. 2% vs. 5. 5%）; hospitalization due to angina pectoris or heart failure（ 16. 6% vs. 15. 0%）; revascularization（ 11. 1% vs. 12. 3%）.There was no significant difference between the two groups in gastrointestinal bleeding（ 5. 6% vs. 5. 5%,P〉0. 05）. Conclusions The effect of two major kinds of PPI on antiplatelet efficacy of clopidogrel has nosignificantly different in patients with NSTEACS.

关 键 词：质子泵抑制剂 血小板聚集抑制剂 急性冠状动脉综合征 氯吡格雷 

分 类 号：R541.4[医药卫生—心血管疾病]