通过CYP2C19抑制功效分类的同时服用克洛皮多格雷尔和质子抑制剂的患者的心血管事件的比较
Seonji Kim1,2, Jimyung Park3, Hsin Yi Chen4
1Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Korea (Seonji Kim, Subin Kim, S.C.Y.).
Arteriosclerosis, thrombosis, and vascular biology
|March 5, 2026
概括
质子抑制剂 (PPI) 在与克洛皮多格雷尔一起使用时不会增加心血管风险,无论PPI的强度如何. 这项研究发现,强和弱CYP2C19抑制PPI之间主要的不良心血管事件没有显著差异.
科学领域:
- 药理学 药理学是指药理学的学科.
- 心血管医学 心血管医学
- 药物相互作用 药物相互作用
背景情况:
- 质子抑制剂 (PPI) 可能会降低克洛皮多格雷尔的抗血小板作用,增加心血管风险.
- 在PPI之间,CYP2C19的抑制有所不同,因此需要根据抑制强度对个人PPI进行研究.
- 很少有国际研究评估了CYP2C19抑制强度对克洛皮多格雷尔使用者的PPI.
研究的目的:
- 在 klopidogrel 患者中,比较强度 CYP2C19 抑制的 PPI 与弱度或非 CYP2C19 抑制的 PPI 之间的心血管事件发生率.
- 评估PPI与接受克洛皮多格雷尔的患者心血管风险之间的关联.
- 评估PPI和克洛皮多格雷尔之间的潜在药物相互作用的临床意义.
主要方法:
- 从1985年到2023年,使用14个数据库 (美国,韩国,台湾) 进行的国际观察队列研究.
- 接受克洛皮多格雷尔和PPI治疗的患者 (≥18岁) 根据CYP2C19抑制强度进行分类.
- 使用1:1倾向分数匹配和Cox比例危险模型来比较主要心血管不良事件 (MACE).
主要成果:
- 大规模的倾向分数匹配确定了166,005对患者.
- 强和弱/非CYP2C19抑制的PPI组之间MACE风险没有显著差异 (17.63对比16.82每1000人年;校准HR,1.00 [95%CI,0.79-1.26]).
- 对于包括心血管死亡率,心肌梗塞,中风和全因死亡率在内的二次结局没有发现显著差异.
结论:
- 同时使用克洛皮多格雷尔和强烈的CYP2C19抑制PPI与更高的心血管风险无关.
- 这项研究不支持PPI和克洛皮多格雷尔之间的潜在相互作用的临床意义.
- 选择PPI强度似乎不会影响服用克洛皮多格雷尔的患者的心血管结果.
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