质子泵抑制剂对氯吡格雷治疗急性冠脉综合征疗效的影响

Therapeutic effect of proton pump inhibitors on efficacy of clopidogrel in treatment of patients with acute coronary syndrome

目的探讨联用质子泵抑制剂(PPI)对氯吡格雷治疗急性冠脉综合征(ACS)患者疗效的影响.方法收集在泰达国际心血管病医院住院的1040例ACS确诊患者的临床资料,根据是否联用PPI分为氯吡格雷组(490例)和氯吡格雷+埃索美拉唑组(550例).氯吡格雷组服用抗血小板药物(阿司匹林和氯吡格雷),并接受常规基础治疗;氯吡格雷+埃索美拉唑组在上述治疗基础上加用埃索美拉唑.比较两组住院期间主要不良心血管事件和消化道出血发生率.结果两组的性别、年龄、危险因素和既往史、疾病类型、是否进行PCI和基础用药情况等一般资料比较差异均无统计学意义(均P>0.05).氯吡格雷组与氯吡格雷+埃索美拉唑组主要不良心血管事件发生率比较差异无统计学意义〔3.7%(18/490)比4.0%(22/550),P>0.05〕,但氯吡格雷+埃索美拉唑组消化道出血发生率明显低于氯吡格雷组〔2.2%(12/550)比6.9%(34/490),P<0.05〕.结论联用PPI可有效预防ACS患者消化道出血,但对预防主要不良心血管事件的发生无明显作用.

Objective To investigate the proton pump inhibitor(PPI)efect on clopidogrel in the treatment of patients with acute coronary syndrome(ACS).Methods The clinical data of 1040 ACS patients admitted to TEDA International Cardiovascular Hospital were collected and divided into a clopidogrel group(490 Cases)and a clopidogrel+esomeprazole group(550 cases)according to whether PPI was combined in treatment.The clopidogrel group was given antiplatelet drugs(aspirin and clopidogrel)and received conventional basic treatment;in clopidogrel+esomeprazole group,on the above mentioned routine basic treatment and clopidogrel,esomeprazole was added.The incidence of major adverse cardiovascular event and gastrointestinal bleeding during hospitalization were compared between the two groups.Results There were no significant differences in gender,age,risk factors,past medical history,disease type.whether combined with per-cutaneous intervention(PCD)and basic medication between the two groups(all P>0.05).There was no significant difference in the incidence of major adverse cardiovascular events between clopidogrel group and clopidogrel+esomeprazole group[3.7%(18/490)vs.4.0%(22/550),P>0.05],however,the incidence of gastrointestinal bleeding in lopidogrel+esomeprazole group was significantly lower than that in clopidogrel group[2.2%(12/550)vs.6.9%(34/490),P<0.05].Conclusion Combination of PPI and clopidogrel can effectively prevent the occurrence of gastrointestinal bleeding in ACS patients,but it has no signifcant effect on the prevention of major adverse cardio-vascular events.