马腾,王斌

• 1:北京大学航天临床医学院心脏中心

摘要(Abstract)：

目的探讨择期经皮冠状动脉介入治疗(PCI)术的患者中,质子泵抑制剂雷贝拉唑对氯吡格雷的血小板聚集率的影响。方法入组120例行择期PCI的冠心病患者,按照病案号的单双号随机分为雷贝拉唑组和对照组。对照组按常规服用阿司匹林、氯吡格雷口服和其他PCI术前准备,雷贝拉唑组在PCI术后加用雷贝拉唑(20mg/d)共7d。比较两组住院期间7d后血小板聚集率以及PCI术后1个月内临床事件的发生率、便潜血的阳性率。结果雷贝拉唑组和对照组二磷酸腺苷(adenosine diphosphate,ADP)诱导的血小板聚集率分别为32.4%和37.1%(P=0.1971),心肌缺血的发生率分别为3.3%和5.0%(P=0.6478),均未发生严重不良临床事件。雷贝拉唑组和对照组便潜血阳性率分别为0%和6.7%(P=0.0419),PCI术后1月随访时便潜血阳性率分别为0%和8.3%(P=0.0224)。结论合用雷贝拉唑对氯吡格雷的抗血小板聚集作用没有明显影响,同时具有保护消化道、减少消化道出血的机会。

关键词(KeyWords)： 氯吡格雷;质子泵抑制剂;雷贝拉唑;细胞色素P450酶系统;血小板聚集

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 马腾,王斌

参考文献(References)：

• [1]Ding Z,Kim S,Dorsam RT,et al.Inactivation of the human P2Y12receptor by thiol reagents requires interaction with both extracellular cysteine residues,Cys17and Cys270.Blood,2003,101:3908-3914.
• [2]Clarke TA,Waskell LA.The metabolism of clopidogrel is catalyzed by human cytochrome P4503A and is inhibited by atorvastatin.Drug Metab Dispos,2003,31:53-59.
• [3]Gerson LB,Triadafilopoulos G.Proton pump inhibitors and their drug interactions:an evidence-based approach.Eur J Gastroenterol Hepatol,2001,13:611-616.
• [4]Gilard M,Arnaud B,Cornily JC,et al.Influence of omeprazole on the antiplatelet action of clopidogrel associated with aspirin:the randomized,double-blind OCLA(Omeprazole CLopidogrel Aspirin)study.J Am Coll Cardiol,2008,51:256-260.
• [5]Ho PM,Maddox TM,Wang L,et al.Risk of adverse outcomes associated with concomitant use of clopidogrel and proton pump inhibitors following acute coronary syndrome.JAMA,2009,301:937-944.
• [6]Juurlink DN,Gomes T,Ko DT,et al.A population-based study of the drug interaction between proton pump inhibitors and clopidogrel.CMAJ,2009,180:713-718.
• [7]O'Donoghue ML,Braunwald E,Antman EM,et al.Pharmacodynamic effect and clinical efficacy of clopidogrel and prasugrel with or without a proton-pump inhibitor:an analysis of two randomised trials.Lancet,2009,374:989-997.
• [8]Sakai T,Aoyama N,Kita T,et al.CYP2C19genotype and pharmacokinetics of three proton pump inhibitors in healthy subjects.Pharm Res,2001,18:721-727.
• [9]Adachi K,Katsube T,Kawamura A,et al.CYP2C19genotype status and intragastric pH during dosing with lansoprazole or rabeprazole.Aliment Pharmacol Ther,2000,14:1259-1266.
• [10]Hokari K,Sugiyama T,Kato M,et al.Efficacy of triple therapy with rabeprazole for Helicobacter pylori infection and CYP2C19genetic polymorphism.Aliment Pharmacol Ther,2001,15:1479-1484.
• [11]Miyoshi M,Mizuno M,Ishiki K,et al.A randomized open trial for comparison of proton pump inhibitors,omeprazole versus rabeprazole,in dual therapy for Helicobacter pylori infection in relation to CYP2C19genetic polymorphism.J Gastroenterol Hepatol,2001,16:723-728.
• [12]Li XQ,Andersson TB,Ahlstrm M,et al.Comparison of inhibitory effects of the proton pump-inhibiting drugs omeprazole,esomeprazole,lansoprazole,pantoprazole,and rabeprazole on human cytochrome P450activities.Drug Metab Dispos,2004,32:821-827.
• [13]Meyer UA.Metabolic interactions of the proton-pump inhibitors,lansoprazole,omeprazole and pantoprazole with other drugs.Eur J Gastroenterol Hepatol,1996,8:S21-S25.
• [14]Andersson T,Miners JO,Veronese ME,et al.Indentification of human liver cytochrome P450isoforms mediating omeprozole metabolism.Br J Clin Pharmacol,1993,36:521-530.
• [15]Andersson T.Pharmacokinetics,metabolism and interactions of acid pump inhibitors.Focus on omeprazole,lansoprazole and pantoprazole.Clin Pharmakinet,1996,31:9-28.
• [16]Carswell CI,Goa KL.Rabeprazole:an update of its use in acid-related disorders.Drugs,2001,61:2327-2356.