不同质子泵抑制剂对急性心肌梗死冠状动脉介入治疗术后氯吡格雷抗血小板功能的影响

Influence of different proton pump inhibitors on platelet function in acute myocardial infarction patients receiving clopidogrel treatment after percutaneous coronary intervention

目的分析急性心肌梗死冠状动脉介入治疗(PCI)术后患者联用氯吡格雷与质子泵抑制剂对上消化道出血及心血管不良事件发生率的影响。方法选取因急性心肌梗死行急诊经皮冠状动脉介入治疗的患者240例,入院后给予负荷量阿司匹林300mg、氯吡格雷600mg后继以阿司匹林100mg/d、氯吡格雷75mg/d双重抗血小板治疗,并随机分为奥美拉唑(40mg/d)组83例,泮托拉唑(40mg/d)组80例,法莫替丁(40mg)组77例。连续用药5~7天,随访1个月,观察消化道出血发生率及支架内再狭窄发生率。结果奥美拉唑与泮托拉唑组出血发生率无差别,但均明显低于法莫替丁组;而支架内再狭窄发生率三组患者比较无明显差别。结论急性心肌梗死PCI术后患者应用质子泵抑制剂未增加支架内再狭窄的风险,与H_2受体拮抗剂相比,能明显降低消化道出血的发生。

Objective To investigate the effect of clopidogrel and proton pump inhibitors （PPIs） on upper gastroin- testinal bleeding and adverse cardiovascular events in acute myocardial infarction （MI） patients after percutaneous coronary intervention （PCI）. Method A total of 240 patients receiving emergent PCI due to acute MI were recrui- ted. After admission, patients were treated with aspirin （300 mg） and clopidogrel （600 mg） on the first day and then with aspirin at 100 mg/d and clopidogrel at 75 mg/d for antiplatelet therapy. These patients were randomly as- signed into Omeprazole （40 mg/d） group （n=83）, Pantoprazole （40 mg/d） group （n=80） and Famotidine （40 mg/d） group （n = 77 ）. Treatment was done for 5 -7 days and patients were followed up for 1 month. The gastroin- testinal bleeding and in-stent restenosis were observed. Result There was no marked difference in the incidence of gastrointestinal bleeding between Omeprazole group and Pantoprazole group, but that in the former two groups was significantly higher than in the Famotidine group. No dramatic difference was observed in the incidence of in-stent restenosis among three groups. Conclusion Treatment with PPI may not increase the rick for in-stent re-stenosis in acute MI patients receiving PCI, but PPI treatment can significantly reduce the incidence of gastrointestinal bleeding when compared with histamine H^-receptor antagonist.