阿司匹林及氯比格雷相关胃损伤治疗新进展  

New progress of Aspirin and Clopidogrel treatment related gastric lesions

作　　者：赵辽辽 陈晶[1] 杜雅菊[1] 

机构地区：[1]哈尔滨医科大学附属第二医院消化内科,黑龙江哈尔滨150086

出　　处：《胃肠病学和肝病学杂志》2016年第4期461-464,共4页Chinese Journal of Gastroenterology and Hepatology

摘　　要：阿司匹林及氯吡格雷相关的胃肠道毒性是一个重要的医疗和社会经济问题。为了预防阿司匹林及氯吡格雷相关的胃肠道毒性,临床常遵循以下6种治疗策略:(1)合用胃保护药物;(2)应用选择性COX-2抑制剂;(3)根除幽门螺杆菌(H.pylori);(4)阿司匹林衍生物;(5)抗氧化剂;(6)中医中药治疗。长期合用质子泵抑制剂(PPI)降低胃肠毒性安全有效。选择性COX-2抑制剂是一类选择性抑制COX-2,但保留胃肠保护COX-1通路的抑制剂。H.pylori增加溃疡的风险,尤其在首次使用非甾体抗炎药(NSAIDs)的患者,因此,长期NSAID治疗或高危患者,建议根除H.pylori。另外,近期有研究报道一种新型阿司匹林衍生物,这种衍生物是通过含钙羟基磷灰石与阿司匹林相互作用得到Ca-阿司匹林,可显著抑制COX-2,而对COX-1没有显著影响,从而不影响前列腺素(PG)的合成。DA-9601是一种抗氧化剂,阿司匹林可能通过白细胞募集及活性氧的产生来引起胃肠道损伤,阻止活性氧的产生可减少胃肠道损伤的发生。中药通过健脾补肾、活血化瘀及疏肝理气减轻胃肠损伤。Aspirin and Clopidogrel related gastrointestinal toxicity is an important medical and social economic problem. In order to prevent the Aspirin and Clopidogrel related gastrointestinal toxicity,6 strategies are followed in clinical routine：（1） conprescription of gastroprotective drug;（2） selective COX-2 inhibitors;（3） the eradication of Helicobacter pylori（ H. pylori）;（4） Aspirin derivatives;（5） Antioxidants;（6） Chinese medicine treatment. Long-term use of PPI is safe and effective. Selective COX-2 inhibitor is a kind of selective inhibition of it,but retain gastrointestinal protection COX-1 channel. H. pylori increases the risk of ulcer,especially in the first use of non-steroidal anti-inflammatory drugs（ NSAIDs） of the patients,therefore,in the long term NSAID treatment before or in high-risk patients,eradication of H. pylori is suggested. In addition,recent studies have reported a new type of Aspirin derivative,the derivative is obtained by interaction between calcium hydroxyapatite and Aspirin,Ca-Aspirin can significantly inhibit COX-2,with no significant influence of COX-1,which does not affect the synthesis of prostaglandin. DA-9601 is an antioxidant that Aspirin may cause leukocyte recruitment and generation of reactive oxygen species to cause gastrointestinal damage,inhibiting the development of ROS in order to reduce the occurrence of gastrointestinal injury. Traditional Chinese medicine can remove blood stasis and soothing liver reduce gastrointestinal injury by invigorating kidney and promoting blood circulation.

关 键 词：阿司匹林 氯比格雷 幽门螺杆菌 质子泵抑制剂 H2受体抑制剂 

分 类 号：R573[医药卫生—消化系统]