不同质子泵抑制剂对ACS患者二联抗血小板治疗效应的影响

Influence of different proton pump inhibitors on effect of bigeminy antiplatelet therapy in patients with acute coronary syndrome

目的:探讨不同质子泵抑制剂(PPI)对急性冠脉综合征(ACS)患者氯吡格雷抗血小板效应的影响。方法:选择ACS患者315例,进行常规阿司匹林和氯吡格雷联合抗血小板治疗,随机分为常规治疗组(90例,不加服PPI),奥美拉唑组(109例),泮托拉唑组(116例)后二组在常规阿司匹林联合氯吡格雷抗血小板治疗的基础上,分别口服奥美拉唑40mg/d、,泮托拉唑40mg/d。分别于治疗前,治疗第7d静脉采血测定二磷酸腺苷(ADP)诱导的血小板聚集率,并观察30d主要不良心血管事件(MACE)。结果:治疗前3组血小板聚集率无显著差异,治疗第7d三组患者血小板聚集率均较治疗前显著下降(P<0.05),且三组血小板聚集率无显著差异(P>0.05);三组患者30d内MACE发生率均无显著差异(P>0.05);奥美拉唑组和泮托拉唑组较常规治疗组消化道并发症发生率显著降低(4.59%比6.04%比15.55%,P<0.05),奥美拉唑组和泮托拉唑组间比较无显著差异(P>0.05)。结论:在急性冠脉综合征患者,奥美拉唑和泮托拉唑对二联抗血小板治疗的总体效应无明显影响,却能显著降低消化道并发症的发生率。

Objective： To investigate influence of different proton pump inhibitors （PPIs） on effect of bigeminy anti- platelet therapy in patients with acute coronary syndrome （ACS）. Methods： A total of 315 ACS patients received routine antiplatelet therapy with aspirin combined clopidogrel. They were randomly divided into routine antiplatelet therapy group （routine treatment group, n = 90, only received routine treatment）, and omeprazole group （n = 109）, pantoprazole group （n= 116）, the subsequent two groups received omeprazole 40 mg/d, antoprazole 40 mg/d re- spectively based on routine antiplatelet therapy. Venous blood was taken before and seventh day after treatment for measurement of platelet aggregation rate induced by adenyl diphosphoric acid （ADP）, and incidence rate of major adverse cardiovascular events （MACE） within 30d was observed in three groups. Results： There was no significant difference in platelet aggregation rate before therapy. Compared with before treatment, there was significant de- crease in platelet aggregation rate in three groups on seventh day after treatment （P〈0.05）; there was no signifi- cant difference in incidence rate of MACE within 30d among three groups （P〉0.05）. Incidence rates of gastroin- testinal complication in omeprazole group and pantoprazole group were significantly lower than that of routine treat- ment group （4.59% vs. 6.04% vs. lfi. 55%, P〈0. 05）, and there was no significant difference between ome- prazole group and pantoprazole group （P〉0.05）. Conclusion.. Neither omeprazole nor pantoprazole has any signifi- cant influence on total efficacy of bigeminy antiplatelet therapy in acute coronary syndrome, but both of them can significantly decrease incidence rate of gastrointestinal complication.