质子泵抑制药的心血管风险及其机制概述  

Cardiovascular Risks and Mechanisms of Proton Pump Inhibitors

作　　者：金晶[1] 谭诗云[2] 张家明[3] 曾繁典[4] Jin Jing;Tan Shiyun;Zhang Jiaming;Zheng Fandian(Department of Otorhinolaryngology Head and Neck Surgery,Zhongnan Hospital,Wuhan University,Wuhan 430071,China;Department of Gastroenterology,People~ Hospital of Wuhan University;Department of Cardiology,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology;Department of pharmacology,Tongji Medical College,Huazhong University of Science and Technology)

机构地区：[1]武汉大学中南医院耳鼻咽喉头颈外科,武汉430071 [2]武汉大学人民医院消化科 [3]华中科技大学同济医学院附属协和医院心内科 [4]华中科技大学同济医学院药理学系

出　　处：《药物流行病学杂志》2018年第11期759-764,共6页Chinese Journal of Pharmacoepidemiology

摘　　要：近年来,质子泵抑制药(PPIs)的不良反应尤其是近期发生心肌梗死、脑卒中以及胃癌的风险被报道以后,其安全性引起了人们的关注和警惕。关于PPIs的心血管不良反应,之前研究主要考虑合用氯吡格雷所致,新的证据表明其风险不仅限于心血管疾病患者,而且出现于普通人群。研究显示,PPIs已成为心梗独立的危险因素,其机制与其降低一氧化氮合酶活性、减少一氧化氮生成等有关。研究同时表明另一类抑酸药物H_2受体拮抗药(H_2RAs)与不良心血管事件关系不大。作为一种具有抑制胃酸分泌和保护消化道黏膜双重作用的新型H2RA拉呋替丁,因其能够促进内皮型一氧化氮合酶(e NOS)增加内源性一氧化氮生成,对于心脑血管疾病患者和担忧PPIs致心脑血管疾病的患者,不失为一种合适的替代药物。In recent years,the adverse reactions of proton pump inhibitors（PPIs） especially associated myocardial infarction,stroke,and gastric cancer have been exposed successively. Their safeties have attracted people’s attention and vigilance. Concerning cardiovascular adverse effects of PPIs,people previously mainly focused on the combination with clopidogrel. New evidence shows that the risks of PPIs are not limited to patients with cardiovascular disease but also to the general population. Studies have shown that PPIs have become an independent risk factor for myocardial infarction,and their mechanisms are related to the reduction of nitric oxide synthase activity and reduction of NO production. Studies have also shown thatH2 receptor antagonists（H2 RAs） are less associated with adverse cardiovascular events. As a novelH2 RA with inhibition of gastric acid secretion and special gastrointestinal mucosal protection,lafutidine can promote endothelial nitric oxide synthase（ e NOS）,increase endogenous NO production,it is a suitable alternative for patients with cardiovascular and cerebrovascular diseases and those who are concerned about cardiovascular and cerebrovascular diseases caused by PPIs.

关 键 词：质子泵抑制药 心血管风险 发生机制 拉呋替丁 

分 类 号：R975.2[医药卫生—药品]