雷贝拉唑对氯吡格雷抗血小板聚集作用的影响

Influence of rabeprazole on the antiplatelet action of clopidogrel

目的探讨择期经皮冠状动脉介入治疗(PCI)术的患者中,质子泵抑制剂雷贝拉唑对氯吡格雷的血小板聚集率的影响。方法入组120例行择期PCI的冠心病患者,按照病案号的单双号随机分为雷贝拉唑组和对照组。对照组按常规服用阿司匹林、氯吡格雷口服和其他PCI术前准备,雷贝拉唑组在PCI术后加用雷贝拉唑(20mg/d)共7d。比较两组住院期间7d后血小板聚集率以及PCI术后1个月内临床事件的发生率、便潜血的阳性率。结果雷贝拉唑组和对照组二磷酸腺苷(adenosine diphosphate,ADP)诱导的血小板聚集率分别为32.4%和37.1%(P=0.1971),心肌缺血的发生率分别为3.3%和5.0%(P=0.6478),均未发生严重不良临床事件。雷贝拉唑组和对照组便潜血阳性率分别为0%和6.7%(P=0.0419),PCI术后1月随访时便潜血阳性率分别为0%和8.3%(P=0.0224)。结论合用雷贝拉唑对氯吡格雷的抗血小板聚集作用没有明显影响,同时具有保护消化道、减少消化道出血的机会。

Objective To investigate the impact of the proton pump inhibitor（PPI）Rabeprazole on platelet aggregation in patients receiving clopidogrel and percutaneous coronary intervention（PCI）.Methods One hundred and twenty elective PCI patients who were prescribed with aspirin and clopidogrel,were randomized to the Rabeprazole group（n = 60,Rabeprazole 20 mg/day）or the control group（n = 60）.Adenosine diphosphate（ADP）-induced platelet aggregation was measured to evaluate the antiplatelet effect of Clopidogrel after 7 days in both groups.Major adverse coronary events（MACE）and occult blood test（OBT）were recorded and analysed during clinical follow-up of 1 months.Results ADP-induced platelet aggregation was 32.4% in the Rabeprazole group and 37.1% in the Control group（P = 0.1971）.The incidence of MACE was similar between the Rabeprazole group and the Control groups（3.3% vs 5%,P = 0.6478）.No patient in the Rabeprazole group had positive OBT.Four patients（6.7%）had positive OBT in the Control group during hospitalization,and five patients（8.3%）in one month follow-up.Conclusion Among patients undergoing PCI treated with aspirin and clopidogrel,rabeprazole could protect the gastrointestinal tract mucosa and reduce alimentary tract hemorrhage without influencing the antiplatelet effect of clopidogrel.