| BackgroundAcute coronary syndrome(ACS) is a group of clinical symptoms caused by acute myocardial ischemia. The common pathological mechanism of ACS is the stability losing of plaques caused by hardening of the coronary artery in the stimulus of various factors. So the losing of stability can lead to the rapture or erosion of the plaque and can induce the formation of thrombosis. Therefore, in the aspect of the treatment of ACS, the concept of the treatment of anti-platelet and anticoagulant were supported strongly. In current time, the efficacy of using aspirin, clopidogrel and anticoagulants combined has been accepted, and became the first treatment strategy recommended by American College of Cardiology/American Heart Association(ACC/AHA) and the European Society of Cardiology(ESC).However, with the pervasion of application of dual anti-platelet in the cardiovascular disease the gastrointestinal injury (including gastrolintestinal inflammation, ulcers, bleeding) has increased too. Also, with the early response of patients with ACS the gastrointestinal complications increased greatly which will affect the therapy of anti-platelet. So it even necessary to stop using the anti-platelet drugs in this siutation, but the subsequent thrombotic events is fatal which makes the clinician in a dilemma. How to choose the appropriate drugs to prevent gastrointestinal damage of patients with ACS has became the common concern of physician clinicians of cardiovascular disease and digestive disease. Serum prostaglandin E2(PGE2)can promote the secretion of gastric mucus and HCO3- which can play a protective role in gastric mucosa. There were no studies on the issue that whether the serum basic level of PGE2 have an effect on gastrointestinal damage caused by anti-platelet drugs.Purpose1.To observe the status of ACS patients with gastrointestinal injury.2. To observe the efficacy in the prevention of gastrointestinal injury in patients of ACS with oral formulation of three drugs repectively. Those three drugs are esomeprazole which is a proton pump inhibitor(PPI), famotidine which is a H2 receptor antagonist(H2RA) and hydrotalcite which is an antacid drug.3. To observe the clinical meaning of serum basic level of PGE2 in the patients of ACS with gastrointestinal injury.Subjects and Method1.182 patients of ACS were selected as the subjects form December 2009 to December 2010 in the Sino-German Heart center of Beijing General Coal hospital. There were 97 male cases and 85 female cases aged from 40 to 91,the average age was 67.15±10.30.2. The basic serum levels of PGE2 of all the patients after admission were determined , and then the basic therapy (antithrombotic, anti-ischemia, etc)was given by the guidelines. The admitted patients were divided into 4 groups randomly. A group(control):basic treatment; B group: basic treatment with fomotidine (20mg,bid); C group: basic treatment with esomeprazole(20mg, bid); D group: basic therapy with hydrotalcite (1000mg,tid).3. All Blood preparations put together and then the level of serum PGE2 were analyzed.4. All the patients were followed up after the treantment.The situation of gastrointestinal damage was observed 3 month after the treatment.5. The control group was divided into two groups according to whether there's digestive tract injury, the incidence of gastrointestinal damage and the risk factors of gastrointestinal injury were analyzed.Results1. There were 182 patients complete the study. There were no significant difference in gender, age, comorbidities, basic medication and the way of treatment(P>0.05). In the 48 cases of the control, 15 cases were found with gastrointestinal injury, the incidence was 31.25%; In the 43 esomeprazole cases, 3 cases were found with digestive tract injury, the incidence was 6.98%; In the 46 cases of the famotidine group, 5 cases were found with gastrointestinal injury, the incidence rate is 10.87%; In the 45 cases of hydrotalcite group, 6 cases were found with gastrointestinal injury, the incidence of 13.33% . There were significant difference in the four groups (X~2=12.089,p=0.007); There's significant difference between group A and B by the pairwise comparison(P=0.004).2. There were no significant difference in the level of serum PGE2 with different groups(P>0.05)and no significant difference in the level of serum PGE2 with different gender.3.In the control group, there's significant difference in the group of digestive tract injury and the group without digestive tract injury with different gende(rχ~2=5.648,P=0.017), there were also significant difference with different age (T=3.745,P=0.001).It's showed significant difference by the comparison of double vessels(χ~2=5.437,P=0.020 )and three vessels (χ~2=7.855,P=0.005)pathological changes. There were significant difference by comparison of CABG(exact probability :P=0.024), ST-segment elevation of myocardial infarction(exact probability : P=0.031) and the level of basic serum PGE2 (T=-4.627,P=0.000). It indicated that the level of basic serum PGE2(OR:1.084),gender(OR:0.009)were the major risk factors of gastrointestinal injury of ACS patients. 4. In the 48 cases of the control, 2 cases (4.17%)were found with angina pectoris,which found with gastrointestinal hemorrhage and aspirin was stopped. coronary arteriongraphy was used to find there was thrombus in the stents and the thrombus were drawed.then we countiue to use the double anti- platelets,and no cardiovascular events were found in the after days.5. In the 45 cases of D group,2 cases (4.44%) were found with diarrhea after taking hydrotalcite.we give them low dose medicines and then the symptom disappeared.Conclusions1.The incidence of gastrointestinal injury of ACS patients was high.2.The gastrointestinal injury of patients with ACS can be prevented safely and effectively with esomeprazole.3.The patients with low basic serum PGE2 level and the female patient were more likely to be have the complications of digestive tract injury. |
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