First Department of Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan.
Digestion. 2013;87(4):281-9. doi: 10.1159/000350438. Epub 2013 Jun 13.
In esophagus whether antiplatelet drugs, such as low-dose aspirin (LDA) and clopidogrel, induce mucosal injury by pH changes or by acid reflux is unclear. We designed to clarify which mechanism was responsible.
In study 1, 80 patients taking LDA and 80 age- and sex-matched subjects who underwent endoscopy for dyspeptic symptoms or for a health check-up were evaluated the endoscopic incidence of esophageal mucosal injury and severity. In study 2, 35 healthy subjects were treated with LDA 100 mg (regimen A), and then 20 randomly selected subjects were dosed clopidogrel 75 mg (regimen C), LDA/clopidogrel (regimen AC), or LDA/clopidogrel/rabeprazole 10 mg for 7 days. Subjects underwent endoscopy and 24-hour pH measurements on day 7.
In study 1, the prevalence of esophageal injury in LDA patients was 40.0%, significantly higher than in non-LDA subjects (25.0%, p = 0.042). In study 2, significant increases in incidence of injury were observed with regimens A (45.8%) and AC (50.0%), but not with C (20.0%), on day 7. Among subjects in whom pH was >5.0 and <4.0 for less than 40% of time, none developed esophageal injury.
LDA caused esophageal injury in half of patients and volunteers. Acid-inhibitory drugs effectively prevented the development of LDA-induced, not clopidogrel, esophageal injury.
在食管中，抗血小板药物（如低剂量阿司匹林[LDA]和氯吡格雷）是通过 pH 值变化还是通过酸反流引起黏膜损伤尚不清楚。我们旨在阐明哪种机制起作用。
在研究 1 中，评估了 80 名服用 LDA 的患者和 80 名年龄和性别匹配的因消化不良症状或健康检查而行内镜检查的受试者的食管黏膜损伤的内镜发生率和严重程度。在研究 2 中，35 名健康受试者接受 LDA 100mg 治疗（方案 A），然后随机选择 20 名受试者接受氯吡格雷 75mg（方案 C）、LDA/氯吡格雷（方案 AC）或 LDA/氯吡格雷/雷贝拉唑 10mg 治疗 7 天。受试者在第 7 天进行内镜检查和 24 小时 pH 测量。
在研究 1 中，LDA 患者的食管损伤发生率为 40.0%，显著高于非 LDA 受试者（25.0%，p=0.042）。在研究 2 中，第 7 天，方案 A（45.8%）和 AC（50.0%）的损伤发生率显著增加，但方案 C（20.0%）没有增加。在 pH 值>5.0 和<4.0 的时间小于 40%的受试者中，没有人发生食管损伤。
LDA 导致一半的患者和志愿者发生食管损伤。抑酸药物可有效预防 LDA 诱导而非氯吡格雷诱导的食管损伤的发生。
