摘要
目的观察质子泵抑制剂(PPIs)能否对经皮冠状动脉介入治疗(PCI)术后双联抗血小板治疗所致胃肠道出血以及可能性支架血栓的发生产生影响,并进一步筛查PCI术后发生胃肠道出血及可能性支架血栓的危险因素。方法选取62例在PCI术后双联抗血小板治疗并最终发生胃肠道出血的患者,并按性别、年龄、居住地、民族等为配比条件选取最终未发生胃肠道出血的患者123例进行1∶2配对病例对照研究。分别统计PCI术后1个月及6个月内发生胃肠道出血的情况,并用同样方法从该人群中选取41例在PCI术后双联抗血小板治疗并最终发生可能性支架血栓的患者及82例最终未发生支架血栓的患者进行1∶2配对病例对照研究。分别统计PCI术后1个月及6个月内发生可能性支架血栓的情况。结果危险因素分析表明,与未使用PPIs相比,PCI术后联合使用PPIs发生胃肠道出血的相对危险度(OR)明显降低[OR=0.120,95%可信区间(CI)为0.055～0.262];使用PPIs治疗1个月与6个月相比,发生上消化道出血的危险无明显差异(P>0.05)。此外,PCI术后发生胃肠道出血还与既往胃肠复合疾病史关系密切(OR=3.520;95%CI为1.253～9.889)。在可能性支架血栓方面,PCI术后有无联合使用PPIs治疗及治疗时间的长短,与发生支架血栓的危险无明显差异(P>0.05);而肾功能不全、既往心肌梗死病史、血小板计数增高等与支架血栓的发生关系密切(OR=9.765,95%CI为3.083～30.928;OR=5.243,95%CI为2.442～11.260;OR=1.014,95%CI为1.006～1.021)。结论 PPIs可以明显减少PCI术后双联抗血小板治疗所致胃肠道出血的危险,使用PPIs时间长短对该保护作用无明显影响,既往胃肠复合疾病史可能是PCI术后发生胃肠道出血的独立高危因素。PPIs对PCI术后双联抗血小板治疗者可能性支架血栓的发生率无明显影响,肾功能不全、既往心肌梗死病史、血小板计数增高可能是其高危因素。
Objective To investigate whether proton pump inhibitors （PPIs） could have an effect on gastrointestinal bleeding induced by dual anti platelet therapy after PCI,and to detect whether PPIs could affect the possible stent thrombosis after PCI, and then to explore the risk factors of the gastrointestinal bleeding and possible stent thrombosis after PCI. Methods 62 patients treated with aspirin and clopidogrel after PCI with or without gastrointestinal bleeding were included in this matched case-control study. The gastrointestinal bleeding within 1 month and 6 months after PCI was observed. Similarly,41 patients treated with aspirin and clopidogrel after PCI with or without stent thrombosis were included. In another matched case-control study from the same population,the same duration was also observed. Results Multivariate logistic analysis showed that the risk of gastrointestinal bleeding in the pa- tients with PPIs was lower compared with no PPIs ones： （OR =0. 120,95 % CI： 0. 055 -- 0. 262） ; No differences were found in the risk of gastrointestinal bleeding between the patients treated with PPIs for 1 month and 6 months after PCI（P〉0.05）. Furthermore,gastrointestinal bleeding after PCI was also associated with the history of gastro intestinal disorders. There were no differences in the risk of possible stent thrombosis in the patients whether used PPIs or not（P〉0.05）. However, possible stent thrombosis after PCI was associated with the comorbidities at dis- charge： renal insufficiency,previous MI,high platelet count （OR=9. 765,95%CI：3. 083-30. 928;OR= 5. 243,95o//99 CI： 2. 442-11. 260;OR=1. 014,95% CI： 1. 006--1. 021）. Conclusion PPIs could reduce the risk of gastrointestinal bleeding induced by dual anti-platelet therapy after PCI. PPIs has no effect on the risk of possible stent thrombosis after PCL The duration of PPIs treatment has no significant effect on the risk of gastrointestinal bleeding. The history of gastrointestinal disorders is the significantly independent risk
出处
《检验医学与临床》
CAS
2011年第17期2058-2060,2062,共4页
Laboratory Medicine and Clinic
关键词
血管成形术
经腔
经皮冠状动脉
阿司匹林
氯吡格雷
胃肠出血
angioplasty, transluminal, percutaneous coronary
aspirin
clopidogrel
gastrointestinal hemorrhage
