河北医科大学学报

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根除幽门螺杆菌在经皮冠状动脉支架植入术后双联抗血小板治疗中的价值

  

  1. 1. 北京中医药大学附属中西医结合医院,北京市中西医结合医院内镜室,北京 100039 ; 2. 北京市
    门头沟区医院心内科,北京 102300 ; 3. 首都医科大学附属北京天坛医院心内科,北京 100050
  • 出版日期:2016-06-25 发布日期:2017-01-16
  • 作者简介:王韶华( 1976- ),男,湖南湘潭人,北京中医药大学 附属中西医结合医院副主任医师,医学硕士,从事消化系统疾病诊治 研究。
  • 基金资助:
    北京市优秀人才培养资助项目( 2011D008017000002 )

The value of the eradication of helicobacter pylori in the treatment of dual antiplatelet therapy after percutaneous coronary stent implantation

  1. 1.Department of Endoscopy, Affiliated Hospital of Beijing University of Traditional Medicine, Beijing
    Hospital of Chinese Traditional And Western Medicine, Beijing 100039， China； 2.Department of
    Cardiology, Beijing Mentougou District Hospital，Beijing 102300， China； 3.Department of
    Cardiology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China
  • Online:2016-06-25 Published:2017-01-16

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摘要： [摘要] 目的 探讨根除幽门螺杆菌( helicobacterpylori , H . pylori )在经皮冠状动脉支架植入术( percutaneous
coronaryinterventions , PCI )后双联抗血小板治疗中的价值。方法 将 282 例合并 H . pylori 感染的 PCI 后患者随
机分为 A 、 B 、 C3 组, 125 例无 H . pylori 感染的 PCI 后患者作为对照组, 4 组均给予双重抗血小板治疗, B 组同时给
予泮托拉唑半年治疗、 C 组同时给予根除 H . pylori 联合泮托拉唑半年治疗,比较各组消化不良症状、上消化道出
血( uppergastrointestinalhemorrhage ,
UGH )及主要不良心血管事件( majoradversecardiovascularevents , MACE )
发生率。结果 消化不良发生率比较, A 组 > 对照组 >B 组 >C 组(
48.9% vs 29.8% vs 19.1% vs 7.5% , P <
0.05 ); UGH 发生率比较, A 组 > 对照组、 B 组 >C 组( 16.0% vs 6.5% 、 7.4% vs 1.1% , P <0.05 ),对照组和 B 组
比较差异无统计学意义( P >0.05 );
4 组 MACE 发生率比较差异均无统计学意义( P >0.05 )。 H . pylori 根除失败
患者 UGH 发生率与根除成功患者比较差异无统计学意义( 6.67% vs 0% , P >0.05 ))。结论 H . pylori 感染可增
加 PCI 后双重抗血小板治疗患者 1 年内消化不良症状和 UGH 的发生;含泮托拉唑的根除 H . pylori 方案联合半
年的泮托拉唑维持治疗可有效预防和减少上述症状,且不增加患者 MACE 的发生。但能否通过上述治疗减少
MACE 的发生需要大样本、长程观察。

关键词: 幽门螺杆菌, 血小板聚集抑制剂, 对比研究

Abstract: ［Abstract］ ObjectiveTo investigate the value of the eradication of helicobacter pylori（Hpylori） in the treatment of dual antiplatelet therapy after percutaneous coronary stent implantation（PCI）. MethodsAfter PCI, 282 cases with Hpylori infection were randomly divided into group A，group B and group C. One hundred and twentyfive patients without Hpylori infection were treated as control group. All the patients in 4 groups were treated with dual antiplatelet therapy. At the same time group B was treated with pantoprazole for six months, group C was treated with Hpylori eradication and pantoprazole for six months. The symptoms of dyspepsia, upper gastrointestinal hemorrhage （UGH） and major adverse cardiovascular events（MACE）were compared. ResultsFor the incidence of dyspepsia, group A> control group> group B> group C(489% vs 298% vs 191% vs 75%,P＜005)；For UGH incidence, group A> control group, group B>group C(160% vs 65%, 74% vs 11%, P＜005), difference between the control group and Group B was not statistically significant(P＞005). For comparing MACE incidence, there were no statistical difference among 4 groups(P＞005). There was no significant difference in the incidence of UGH in patients with pylori H. eradication failure(67% vs 0%, P＞005).  ConclusionHpylori infection can increase symptoms of dyspepsia and the incidence of UGH within one year after PCI and dual antiplatelet therapy in patients. The Hpylori eradication program containing pantoprazole combined with a half year of pantoprazole therapy can effectively prevent and reduce those symptoms, and does not increase the incidence of MACE. However, whether it can reduces the incidence of MACE needs large samples and longrange observation.

Key words: ［Key words］helicobacter pylori； platelet aggregation inhibitors, compatrative study

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