口服奥美拉唑对双联抗血小板药物疗效的影响

Influence of oral omeprazole on effect of coupled antiplatelet drugs

目的评价口服奥美拉唑对双联抗血小板药物作用的影响及其临床意义。方法入选2011年1月至5月择期行经皮冠状动脉介入治疗(PCI)的患者119例,分为2组。对照组68例,给予口服阿司匹林+氯吡格雷治疗;研究组51例,给予口服阿司匹林+氯吡格雷+奥美拉唑治疗。检测所有患者血栓弹力图中二磷酸腺苷(ADP)和花生四烯酸(AA)途径诱导的血小板抑制率,并对两组进行比较。同时对比两组患者术后3个月内发生心绞痛伴心电图ST段压低、心肌酶升高和心脏缺血事件的发生率。结果两组患者临床相关资料及随访缺血事件相比无统计学差异;两组患者血小板AA途径抑制率差异无统计学意义,对照组ADP途径抑制率高于研究组,差异有统计学意义(P<0.05)。结论口服奥美拉唑可减弱氯吡格雷的抗血小板作用,但是对择期PCI患者,短期应用奥美拉唑时,常规双联抗血小板治疗仍安全有效。

Objective To review the influence and clinical significance of omeprazole on the effect of coupled antiplatelet drugs.Methods The patients（n=119） with optional percutaneous coronary intervention（PCI） were selected from Jan.2011 to May 2011,and then they were divided into the control group（n=68） treated with aspirin and clopidogrel,and test group（n=51） treated with aspirin,clopidogrel and omeprazole.The platelet inhibitory rate was detected and compared induced by pathway of adenosine diphosphate（ADP） and pathway of arachidonic acid（AA） in thrombelastogram in all patients.The incidence rates of angina accompanied by ECG ST-segment depression,increased of cardiac enzyme and heart ischemic events within 3 months were compared between two groups.Results There were no statistical difference in clinical materials and follow-up heart ischemic events between two groups.The platelet inhibitory rate by AA pathway was not different statistically between two groups,and that by ADP pathway was higher in the control group than that in the test group（P0.05）.Conclusion Oral omeprazole can reduce the antiplatelet effect of clopidogrel,but coupled antiplatelet drugs still is safe and effective during short-term administration of omeprazole in patients with optional PCI.