奥美拉唑不同服药时间对氯吡格雷抗血小板效应的影响

Different time of taking omeprazole on clopidogrel antiplatelet aggregationin patients with acute coronary syndrome

目的:探讨分开氯吡格雷和奥美拉唑的服药时间对氯吡格雷抗血小板效应的影响。方法:入选急性冠状动脉综合征(ACS)患者56例,将其随机分为A组:单用氯吡格雷(21例);B组:氯吡格雷+奥美拉唑(20例);C组:氯吡格雷+奥美拉唑,间隔10～12h(15例)。采用PCR-RFLP检测患者的细胞色素P450(cytochromeP450,CYP)2C19*2和*3基因型,比浊法检测服药前及服药1d、5d的最大血小板聚集率(MPAR)。结果:3组CYP2C19*2和*3基因型的分布差异无统计学意义。服药1d和5d总的氯吡格雷抵抗发生率分别为42.86%和46.43%。服药1d后,A组MPAR与B、C组比较均差异有统计学意义(均P<0.05),而B组和C组差异无统计学意义。结论:联用奥美拉唑降低了氯吡格雷抗血小板效应,分开氯吡格雷和奥美拉唑服药时间不能减轻奥美拉唑对氯吡格雷的影响。

Objective： To assess the effect of antiplatelet aggregation of clopidogrel through separating clopi- dogrel and omeprazole dosing on. Method：Fifty-six patients with acute coronary syndrome （ACS） were enrolled in this trail. According to whether taking omeprazole and different time of taking drugs, they were randomly divided into group A ： clopidogrel only （n = 21 ）, group B ： clopidogrel plus omeprazole （n ： 20）, group C ： clopidogrel and omeprazole administered apart 10- 12 hours （n= 15）. CYP2C19 ＊ 2 and ＊ 3 genotype of patients were detected by polymerase chain reaction restriction fragment length polymorphism analysis （PCR RFLP）. Maximum platelet aggregation rate （MPAR） was tested by nephelometry after taking clopidogrel and omeprazole at 0 d, 1 d and 5 d. Result：Distribution of CYP2C19 ± 2 and ± 3 were not different among the three groups. The totle rates of clopi dogrel resistance in 1 d and 5 d were 42.86% （24/56） and 46.43% （26/56） respectively. The MPAR of Medica- tion after 1 d in Group A （42.77±17. 17）% was obviously lower than that in Group B （54.36±19.82）% and Group C （58.61±14.50） % （both P〈0.05）, and no remarkable difference existed between Group B and Group C （P）〉0.05）. Conclusion： Omeprazole decreases the antiplatelet aggregation effect of clopidogrel and increases the rate of clopidogrel resistance. Clopidogrel and omeprazole administered apart could not minimize the influence.