质子泵抑制剂对氯吡格雷抗血小板疗效影响的观察

The Evaluation of the Influence of Proton Pump Inhibitors on Clopidogrel Antiplatelet Effects

目的：为进一步观察和探讨不同质子泵抑制剂泮托拉唑、雷贝拉唑对氯吡格雷抗小板疗效的影响。方法：入选2009年12月~2011年3月入住我院心血管内科的急性冠脉综合征患者与择期行经皮冠状动脉介入治疗患者154例,随机分为对照组（单用氯吡格雷组）51例;实验组1（联用泮托拉唑80 mg/d组）62例;实验组2（联用雷贝拉唑10 mg/d组）41例,所有入选患者均给予负荷剂量氯吡格雷300 mg,后以氯吡格雷75 mg/d,拜阿司匹林片100 m/d维持。连续治疗7~10 d,通过流式细胞仪分别测定治疗前和治疗第7 d血小板P选择素阳性率（用%表示）,然后对各项指标进行统计学分析。结果：实验组1（治疗前后血小板P选择素阳性率分别为（9.14±4.82,4.03±2.72）,实验组2（治疗前后血小板P选择素阳性率分别为9.16±4.92,6.41±2.83）和对照组（治疗前后血小板P选择素阳性率分别为10.34±6.84,5.24±6.40）,3组治疗前后的血小板活性度（paired-smaples test）均明显降低,差异均有统计学意义（P=0.000〈0.05）,3组间两两比较治疗前（P=0.27,0.96,0.36〉0.05）,治疗后（0.18,0.32,0.28〉0.05）,差异无统计学意义。结论：①是否联用质子泵抑制剂在对氯吡格雷的抗血小板疗效方面无差别。②质子泵抑制剂泮托拉唑与雷贝拉唑相同均在近期内不影响氯吡格雷的抗血小板疗效。

Objective：To further investigate the influence of proton pump inhibitors,such as Pantoprazole and Rabeprazole,on clopidogrel antiplatelet effects.Methods：154 cases with acute coronary syndrome and percutaneous coronary intervention were selected,and had checked by cardiovascular physician in Inner Mongolia autonomous region people＇s hospital form December 2009 to March 2011.All patients were randomly divided into three groups.The experimental group 1（62cases） were given clopidogrel 75 mg·d-1and pantoprazole 80 mg·d-1;The experimental group 2（41cases） were given clopidogrel 75 mg·d-1 and rabeprazole 10 mg·d-1;The control group（51 cases） were given only clopidogrel 75 mg·d-1.All patients recieved a clopidogrel loading doses 300 mg at the start of clopidogrel treatment,and then given clopidogrel 75 mg·d-1 and Aspirin300 mg·d-1 for seven to ten days by continuous.The Flow Cytometric was used to analysis platelet P-selectin positive rate（%）,before treatment and the seventh day after taking medicine and then statistical analysis was performed.Results：Before and after the treatment,the platelet P-selectin positive rate（%） of the control group was 10.34±6.84 and 5.24±6.40 respectively（P0.05）;the platelet P-selectin positive rate of the experimental group 1 was 9.14±4.82 and 4.03±2.72 respectively（P0.05）;the platelet P-selectin positive rate of the experimental group 2 was 9.16±4.92 and 6.41±2.83 respectively（P0.05）.Camparing between every two groups,there was no the difference（P0.05）.Conclusions：①There is no significance between patients taking clopidogrel plus PPI and clopidogrel without PPI.②The thrapeutic doses of Pantoprazole and Rabeprazole has no effect on Clopidogrel of antiplatelet curative effect in short period.