CAJ | 학술논문

近年来,临床研究发现氯吡格雷合用质子泵抑制剂(proton pump inhibitors, PPI)可能会增加急性冠脉综合征(acute coronary syndrome, ACS)或经皮冠状动脉介入(percutaneous coronary intervention, PCI)术后患者心血管不良事件发生的风险,因此,联合用药存在争议.本文从氯吡格雷与CYP2C19多态性、PPI与氯吡格雷在药理及临床作用上的相互影响、相关临床研究来深入解析药物相互作用.药代动力学研究的Meta分析结果显示,PPI可能削弱了氯吡格雷抗血小板的效应.10个临床观察性研究都体现了这个观点,但文献质量偏低,而其余3篇低质量的观察性研究、5篇中等质量的观察性研究和1篇高质量的RCT均未发现氯吡格雷合用PPI会显著增加患者心血管不良事件的发生风险.
근년래,림상연구발현록필격뢰합용질자빙억제제(proton pump inhibitors, PPI)가능회증가급성관맥종합정(acute coronary syndrome, ACS)혹경피관상동맥개입(percutaneous coronary intervention, PCI)술후환자심혈관불량사건발생적풍험,인차,연합용약존재쟁의.본문종록필격뢰여CYP2C19다태성、PPI여록필격뢰재약리급림상작용상적상호영향、상관림상연구래심입해석약물상호작용.약대동역학연구적Meta분석결과현시,PPI가능삭약료록필격뢰항혈소판적효응.10개림상관찰성연구도체현료저개관점,단문헌질량편저,이기여3편저질량적관찰성연구、5편중등질량적관찰성연구화1편고질량적RCT균미발현록필격뢰합용PPI회현저증가환자심혈관불량사건적발생풍험.
Some clinical researches showed that combination use of proton pump inhibitors (PPIs) and clopidogrel might be associated with increased risks of cardiovascular events in patients with acute coronary syndrome or after percutaneous coronary intervention. This article discussed and analyzed the controversial questions regarding clopidogrel and CYP2C19 polymorphism, the interaction between PPIs and clopidogrel in pharmacology and clinical effect and the possible suggestions by reviewing the published studies. A meta-analysis of pharmacokinetic studies showed that PPIs might attenuate the antiplatelet effect of clopidogrel. Ten observational researches with poor quality stated that combination use of PPIs and clopidogrel might increase the risk of cardiovascular events, while three other low quality observational studies, five moderate quality observational studies and one high quality randomized controlled trial found no significant relationship between combination use of PPIs and clopidogrel and increased risks of cardiovascular events.