摘要
目的探讨中国中部地区汉族急性冠状动脉综合征(ACS)患者CYP2C19基因多态性的分布特点,观察不同基因型患者在经皮冠状动脉介入术(PCI)后应用氯吡格雷抗血小板治疗的效果,并分析CYP2C19基因检测在PCI术后患者治疗者中的价值。方法纳入258例接受PCI的ACS患者,对所有患者进行CYP2C19基因型检测。依据CYP2C19基因检测结果,将患者分为快代谢组、中等代谢组和慢代谢组,并于服药后1 h、24 h及7 d后抽血,采用血栓弹力图检测血小板聚集抑制率(IPA)。随访3个月,记录三组药物不良反应及主要不良心血管事件(MACE)发生情况。结果快代谢组、中等代谢组和慢代谢组分别有108例(41.9%)、117例(45.3%)和33例(12.8%)患者,服药后24 h和7 d时,慢代谢组IPA均显著低于快代谢和中等代谢组(P<0.05);慢代谢组药物不良反应及MACE事件发生率高于其他两组,但无显著差异(P>0.05)。结论携带CYP2C19慢代谢基因型患者常规应用氯吡格雷抗血小板治疗作用减弱,CYP2C19基因检测对ACS患者PCI术后抗血小板治疗具有一定指导价值。
AIM To discuss the distribution characteristics of CYP2C19 gene polymorphism of Han patients with acute coronary syndrome （ACS） in central region of China, and observe the effect of antiplatelet therapy with clopidogrel on patients with different genotypes after percutaneous coronary intervention （PCI）, and analyze the value of CYP2CI9 gene polymorphisms detection in patients after PCI. METHODS A total of 258 ACS patients treated with PCI were enrolled in our hospital. All patients were drawn blood for CYP2CI9 gene polymorphisms detection. According to the results of CYP2C19 gene detection, the patients were divided into fast metabolism group, secondary metabolic group, and slow metabolism group. Inhibition platelet aggregation （IPA） and platelet activity were detected by thromboelastogram （TEG） in 1 h, 24 h and 7 d respectively after taking clopidogrel. Clinical data were collected, patients were followed up three months after PCI, adverse drug reactions （ADR） and major adverse cardiovascular events （MACE） were recorded. RESULTS The number and proportion of the fast metabolism group, the secondary metabolic group and the slow metabolism group were 108 （41.9%）, 117 （45.3%） and 33 （12.8%）, respectively. The IPA of patients in the slow metabolism group was lower than that in the fast metabolism and the secondary metabolic group in 24 h and 7 d （P 〈 0.05）. The ADR and MACE incidence in the slow metabolism group was higher than that in the last metabolism and the secondary metabolic group （P 〉 0.05）. CONCLUSION The effect of routine antiplateJe/ therapy with clopidogrel is reduced in patients with CYP2C19 slow metabolism genotype. The CYP2C19 gene polymorphisms screening has certain guiding value in antiplatelet therapy for PCI patients with ACS.
作者
兰丙欣
徐炳欣
赵艳
赵亮
郭树领
LAN Bing-xin XU Bing-xin ZHAO Yan ZHAO Liang GUO Shu-ling(Xuchang Central Hospital, Xuehang HE-NAN 461000, China Xuchang Key Laboratory of Molecular Medicine, Xuchang HE-NA N 461000, China)
出处
《中国新药与临床杂志》
CSCD
北大核心
2017年第7期413-416,共4页
Chinese Journal of New Drugs and Clinical Remedies
基金
河南省医学科技攻关项目(201303210)
