质子泵抑制剂对冠状动脉介入术后患者氯吡格雷抵抗和再发心血管事件的影响

目的:探讨中国福建地区汉族患者择期经皮冠状动脉介入治疗(PCI)术后,质子泵抑制剂(PPI)对实验室氯吡格雷抵抗(LCR)的影响及与再发心血管事件(CVEs)之间的关系。方法:观察345例择期PCI术患者,收集患者服药前后最大血小板聚集率(MPA)和中位数为7个月随访期间CVEs再发的情况。结果:①氯吡格雷联合胃药组的MPA下降幅度明显低于未联合胃药组(P=0.009);氯吡格雷联合PPI组的MPA下降幅度明显低于未联合PPI组(P<0.01);进一步分析发现,氯吡格雷联合泮托拉唑组的MPA下降幅度明显高于奥美拉唑组和其他PPI组(P=0.004)。②服用胃药组的LCR和再发CVEs发生率明显高于未服用胃药组(38.5%∶23.3%,P=0.019;20.6%∶10.0%,P=0.039);服用PPI组的LCR和再发CVEs发生率明显高于未服用PPI组(48.4%∶27.6%,P<0.01;25.8%∶13.8%,P=0.001);奥美拉唑组的再发CVEs明显高于泮托拉唑组和其他PPI组(P=0.035);并且发现氯吡格雷联合奥美拉唑是PCI术后再发CVEs的独立危险因素(P=0.002,RR=3.486,95%CI=1.595～7.618)。结论:PCI术后服用PPI(尤其是奥美拉唑)时,可能会减弱氯吡格雷的疗效,增加心血管不良事件的风险。

Effect of proton pump inhibitors on clopidogrel resistance and recurrence of cardiovascular events in patients undergone percutaneous coronary intervention

Objective:To study the influence of proton pump inhibitor(PPI) on the therapeutic efficacy of clopidogrel and recurrence of cardiovascular events(CVEs) in Chinese Han patients undergone elective percutaneous coronary intervention(PCI). Method:The rate of maximal platelet aggregation(MPA),LCR and the recurrence of CVEs after a follow-up for median 7 months were investigated in 345 patients(male: 250;female: 95) after PCI. Result:①The degree of the decrease in the MPA was significantly lower in those with clopidogrel concomitant use of gastric agents than those with unused of gastric agents(P=0.009).The degree of the decrease in the MPA was significantly lower in those with clopidogrel concomitant use of PPI than those with unused of PPI(P<0.001).The degree of the decrease in the MPA was significantly higher in those with clopidogrel concomitant use of pantoprazole than those with concomitant use of omeprazole and other PPI(P=0.004).②There were higher rate of LCR(38.5% vs 23.3%,P=0.019) and recurrence of CVEs(20.6% vs 10.0%,P=0.039) in clopidogrel concomitant use of gastric agents than unused of gastric agents.There were higher rate of LCR(P<0.001) and recurrence of CVEs(P=0.001) in clopidogrel concomitant use of PPI than unused of PPI.There was higher rate of recurrence of CVEs in omeprazole than other PPI(P=0.035).Clopidogrel concomitant use of omeprazole was an independent risk factor of recurrence CVEs after PCI(P=0.002,RR=3.486,95%CI=1.595-7.618). Conclusion:PPI(especially omeprazole) may weaken the antiplatelet effect of clopidogrel,and increase the risk of CVEs after PCI.