低剂量氯吡格雷和阿司匹林联用致血尿

Hematuria due to concomitant use of low dose clopidogrel and aspirin

1例76岁男性急性冠状动脉综合征患者行经皮冠状动脉支架置入术后规律口服阿司匹林（0.1g、1次/d）、氯吡格雷（50 mg、1次/d）、阿托伐他汀钙（20 mg、1次/d）和单硝酸异山梨酯（10 mg、2次/d）.2个月后突发左侧腰痛伴肉眼血尿.实验室检查：尿隐血（＋＋＋）,红细胞235个/μl,红细胞19个/高倍视野.泌尿系统超声和肾功能检查未见明显异常.停用氯吡格雷和阿司匹林,并给予对症治疗.2d后患者尿液恢复正常,左侧腰痛明显好转,尿红细胞阴性.细胞色素P450 （CYP）2C19基因多态性检测显示患者携带CYP2C19＊ 17等位基因,即CYP2C19酶为超快代谢型.继续给予患者阿司匹林等口服治疗,患者未再出现血尿.

A 76-year-old male patient with acute coronary syndrome received regularly aspirin （0.1 g once daily）,clopidogrel （50 mg once daily）,atorvastatin calcium （20 mg once daily）,and isosorbide mononitrate （10 mg twice daily） by mouth after undergoing percutaneous coronary intervention.He suffered from left lumbago with gross hematuria after 2 months of treatments.Laboratory tests showed the following values：urine occult blood（＋＋＋）,235 red blood cells per microlitre and 17 red blood cells per high power field.Urinary system ultrasonography and renal function detection showed no abnormalities.Aspirin and clopidogel were withdrawn and the symptomatic treatments were given.Two days later,the patient’s urine recovered to normal,his left lumbago was alleviated,and the red blood cell in his urine was negative.Gene polymorphism detection of cytochrome P-450 （CYP）2C19 showed that the patient carried CYP2C19 ＊17（CT） allele and CYP2C19 enzyme had ultra rapid metabolism.Aspirin was given orally and the hematuria did not appear again.