摘要
目的研究CYP1A2和CYP2C19基因多态性与老年稳定性冠心病患者一级预防和二级预防不良预后的关系。方法选取2017年4月~7月在解放军总医院老年病科进行体检的长期口服氯吡格雷的男性患者241例,年龄均>60岁。根据是否明确诊断患有冠心病分为一级预防组123人和二级预防组118人。所有患者入组后静脉采血,检测血小板聚集功能和CYP1A2和CYP2C19基因多态性,并且随访至2019年4月,记录主要不良心脑血管事件(MACCE)的发生情况。采用SPSS 23.0统计软件进行数据处理,分别采用t检验、Pearson卡方检验对组间数据进行比较,预后结局比较采用多因素Cox比例风险模型。结果分别按照CYP1A2和CYP2C19两个基因的突变情况分为快代谢组和中慢代谢组,各分组之间ADP和AA诱导的血小板聚集度之间比较均无差异(P>0.05)。多因素Cox生存分析显示,在一级预防组中,仅年龄为独立危险因素(HR=1.074,95%CI 1.003~1.150);在二级预防组中,年龄(HR=1.036,95%CI 1.000~1.075)和糖尿病(HR=1.990,95%CI 1.071~3.696)为独立危险因素。在两组中CYP2C19分型、CYP1A2分型对于预后均无影响(P>0.05)。结论CYP1A2和CYP2C19的基因分型对于稳定性冠心病一级预防和二级预防的老年人群的血小板聚集功能以及2年内MACCE的发生没有显著影响。
Objective To investigate the relationship of polymorphisms of CYP1A2 and CYP2C19 with prognosis of stable coronary heart disease in elderly patients receiving primary or secondary prevention.Methods A total of 241 men aged≥60 years were enrolled,who was on long-term oral clopidogrel and received their annual health examination in Chinese PLA General Hospital between April and July 2017.The patients were divided,based on diagnosis of coronary heart disease,into primary prevention group(n=123)and secondary prevention group(n=118).For all patients,blood samples were collected on admission,platelet aggregation was measured,polymorphisms of CYP1A2 and CYP2C19 were assayed,and major adverse cardiovascular and cerebrovascular events(MACCE)were recorded during the follow-up as of before April 2019.The data were processed by SPSS statistics 23.0.t test and Pearson chi-square test were performed to compare the data between groups,and multivariate Cox proportional hazard model was used to compare the outcomes.Results According to polymorphisms of CYP1A2 and CYP2C19,all patients were divided into fast metabolism group and medium/slow metabolism group,and platelet aggregations induced by ADP and AA of the two groups were not significantly different(P>0.05).Multivariate Cox survival analysis showed that only age[hazard ratio(HR)=1.074,95%confidence interval(CI):1.003-1.150]was independent risk factor in primary prevention group,and that,after adjusting for baseline characteristics,age(HR=1.036,95%CI:1.000-1.075)and diabetes(HR=1.990,95%CI:071-3.696)were independent risk factors in secondary prevention group.However,the phenotypes of CYP2C19 and CYP1A2 had no effects on the prognosis(P>0.05).Conclusions The phenotypes of CYP1A2 and CYP2C19 had no significant effect on the platelet aggregation function and the risk of MACCE in the elderly patients receiving primary or secondary prevention with stable coronary heart disease.
作者
蔡雨伦
徐伟豪
李曼
李慧颖
周文丽
李月蕊
刘宏斌
CAI Yu-Lun;XU Wei-Hao;LI Man;LI Hui-Ying;ZHOU Wen-Li;LI Yue-Rui;LIU Hong-Bin(Department of Geriatric Cardiology, Second Medical Center, National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing 100853, China)
出处
《中华老年多器官疾病杂志》
2020年第5期326-330,共5页
Chinese Journal of Multiple Organ Diseases in the Elderly
基金
国家重点研发专项(2017YFC0840103)。
关键词
单核苷酸基因多态性
氯吡格雷
冠心病
single nucleotide polymorphisms
clopidogrel
coronary heart disease
