埃索美拉唑对氯吡格雷抑制血小板作用的影响

目的观察埃索美拉唑对氯吡格雷血小板抑制作用的影响。方法 151例接受经皮冠脉介入治疗的冠状动脉疾病患者,均接受氯吡格雷负荷量600 mg治疗,在进入研究时,患者已经平均接受了3个月（至少5 d）的氯吡格雷（75 mg.d-1）和阿司匹林（100 mg.d-1）治疗。其中76例在此基础上给予埃索美拉唑（20 mg,bid）治疗,作为实验组;另外75例作为对照组。结果血小板反应指数在实验组（n=76,总体均数51%,范围48%～54%）和对照组（n=75,总体均数49%,范围43%～55%;P=0.718）的患者中几乎完全相同。埃索美拉唑（n=76;PRI=54%;聚集度42 U）和对照组（n=75;PRI=49%;聚集度=41 U;P=0.373）的患者之间,PRI或者二磷酸腺苷诱导的血小板聚集度没有差异。结论对于接受氯吡格雷治疗且同时需要抑酸干预的患者,需要质子泵抑制剂（PPI）治疗时,应尽可能的选择相互作用影响小的埃索美拉唑。

Effect of esomeprazole on clopidogrel-induced platelet inhibition

Objective To investigate the effect of esomeprazole on platelet inhibition induced by clopidogrel.Methods Response to clopidogrel was assessed by the vasodilator-agent stimulated phosphoprotein（VASP） assay and aggregometry（multiplate analyzer） in 151 patients with coronary artery disease（CAD） undergoing percutaneous coronary intervention（PCI）.All patients received a clopidogrel loading dose（600 mg） at the start of clopidogrel treatment.Patients had been treated with clopidogrel（75 mg·d-1） and aspirin（100 mg·d-1） for 3 months on average（5 days at least）.Esomeprazole was used in the study.Results The mean platelet reactivity index（PRI,assessed by the VAS Passay）was nearly the same in patients with esomeprazole（n=76;PRI = 54%） or in the control group（n=75;PRI = 49%;P=0.718）.There was no difference in the PRI or the adenosine diphosphate-induced platelet aggregation between patients with esomeprazole（n=76;PRI=54%;aggregation=42 U）,or patients without PPI（n=75;PRI=49%;aggregation=41 U;P=0.373）.Conclusion Doctors had better choose esomeprazole with a small interaction to treat patients who received clopidogrel therapy and acid suppression intervention when needing PPI treatment.