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目的:比较奥美拉唑及法莫替丁对于经皮冠状动脉介入术后双重抗血小板治疗患者血小板聚集率以及临床预后的不同影响。方法:选取自2009年6月~2011年11月应用阿司匹林及氯吡格雷行双重抗血小板治疗,并行PCI术患者,于双重抗血小板治疗第5天时测血小板聚集率。然后随机将患者分为奥美拉唑治疗组及法莫替丁治疗组,分别给予奥美拉唑40mg/d及法莫替丁40mg/d,分组7天后再次检测血小板聚集率。观察患者在加用奥美拉唑或法莫替丁前后,血小板聚集率有无变化。随访1年,观察2组间在不良心血管事件以及消化道损伤事件方面有无差异。另外行亚族分析,观察2组间氯吡格雷低反应患者不良心血管事件是否存在差异,以及消化道损伤高危患者的消化道损伤事件是否有差异。结果:最终奥美拉唑治疗组入选179名患者,法莫替丁治疗组入选167名患者。奥美拉唑治疗组应用奥美拉唑后血小板聚集率显著升高(41.57±19.89)%VS(51.04±17.54)%,P<0.001,而法莫替丁组用药前后无统计学差异(42.83±20.10)%VS(41.93±19.30)%,P=0.055。随访1年,2组间不良心血管事件无统计学差异(7 VS 4,Log Rank P=0.417);氯吡格雷低反应亚族分析,2组间无统计学差异(7 VS 2,Log Rank P=0.077),但奥美拉唑有增加不良心血管事件趋势。2组间消化道损伤事件存在统计学差异(2 VS 10,Log Rank P=0.014),奥美拉唑较法莫替丁更能减少消化道损伤事件发生(HR=0.183,95%CI:0.040-0.834)。消化道损伤高危患者亚族分析,2组间存在统计学差异(2 VS10,Log Rank P=0.016),奥美拉唑可以减少上述人群消化道损伤事件发生(HR=0.190,95%CI:0.042-0.869)。结论:奥美拉唑降低氯吡格雷抗血小板聚集的作用,法莫替丁无此作用。奥美拉唑较法莫替丁未显著增加不良心血管事件,但对于氯吡格雷低反应患者可能会增加不良心血管事件。奥美拉唑预防消化道损伤优于法莫替丁。
OBJECTIVE: To compare the different effects of omeprazole and famotidine on platelet aggregation and clinical prognosis in patients treated with dual antiplatelet therapy after percutaneous coronary intervention. Methods: From June 2009 to November 2011, patients were treated with aspirin and clopidogrel dual antiplatelet therapy and PCI. The platelet aggregation rate was measured on the 5th day of dual antiplatelet therapy. Patients were then randomly divided into omeprazole treatment group and famotidine treatment group, were given omeprazole 40mg / d and famotidine 40mg / d, sub-group 7 days after re-testing platelet aggregation rate. Observed in patients with plus omeprazole or famotidine before and after, platelet aggregation rate with or without change. After one year of follow-up, we observed whether there were any differences in adverse cardiovascular events and gastrointestinal lesion events between the two groups. Another line of sub-ethnic analysis, observed two groups of patients with low response to clopidogrel adverse cardiovascular events are there any differences, and high-risk patients with gastrointestinal tract injury of gastrointestinal lesions are there any differences. Results: Of the 179 patients enrolled in the final omeprazole-treated group, 167 patients were enrolled in the famotidine group. The omeprazole treatment group was significantly increased (41.57 ± 19.89)% VS (51.04 ± 17.54)%, P <0.001 after omeprazole treatment, and no significant difference was found between famotidine group and control group (42.83 ± 20.10)% VS (41.93 ± 19.30)%, P = 0.055. There was no significant difference in adverse cardiovascular events between the two groups at follow-up of 1 year (7 VS 4, Log Rank P = 0.417); there was no significant difference between the two subgroups of clopidogrel response (7 VS 2, Log Rank P = 0.077), but omeprazole increased the trend of adverse cardiovascular events. Omeprazole was more effective than famotidine in reducing the incidence of gastrointestinal lesion events (HR = 0.183, 95% CI: 0.040) with statistical significance (2 vs 10, Log Rank P = 0.014) -0.834). There was a statistically significant difference between the 2 groups (2 VS10, Log Rank P = 0.016). Omeprazole could reduce the incidence of gastrointestinal injury in these groups (HR = 0.190, 95% CI: 0.042 -0.869). CONCLUSION: Omeprazole reduces the antiplatelet effect of clopidogrel, with no effect of famotidine. Omeprazole did not significantly increase adverse cardiovascular events compared with famotidine, but patients with low response to clopidogrel may have increased adverse cardiovascular events. Omeprazole is superior to famotidine in preventing gastrointestinal damage.