摘要
目的探讨携带和未携带CYP2C19功能缺陷基因的急性冠状动脉综合征(ACS)患者选择不同P2Y12抑制剂与其远期预后的相关性。方法连续入选2016年3月至2016年10月于天津市第三中心医院接受经皮冠状动脉介入治疗(PCI)的ACS患者289例,进行CYP2C19基因多态性检测,分为携带CYP2C19功能缺陷基因组(A组,199例)和未携带CYP2C19功能缺陷基因组(B组,90例)。PCI术后选择不同的P2Y12抑制剂,随访3年,失访23例,最终A组入组182例,B组入组84例。根据随访3年内有无主要心血管不良事件(MACE),将A、B组各分为MACE亚组(58例、32例)和无MACE亚组(124例、52例)。收集患者的临床资料、冠状动脉病变与介入情况以及术后药物治疗方案,对A、B组内两亚组进行单因素分析,将差异具有统计学意义(P<0.05)的危险因素入选,再分别对A、B组进行多因素Logistic回归分析,比较不同P2Y12抑制剂对两组患者预后的影响。结果A组中两亚组间比较,血小板体积、空腹血糖、血肌酐、糖化血红蛋白(HbA1c)、左心室舒张末期内径、单支病变比例、干预左主干病变比例及双联抗血小板治疗方案差异均具有统计学意义(均P<0.05);B组中两亚组间比较,低密度脂蛋白、射血分数、左心室舒张末期内径、双支病变、三支病变比例及术中使用替罗非班比例差异均具有统计学意义(均P<0.05)。多因素Logistic回归分析结果显示,在A组患者中,不同的P2Y12抑制剂是影响其远期预后的独立危险因素,与替格瑞洛方案相比,氯吡格雷75 mg/d方案患者远期MACE的发生风险是其12.971倍(OR=12.971,95%CI:5.028~33.464,P<0.001),氯吡格雷100 mg/d方案患者远期MACE的发生风险是其6.029倍(OR=6.029,95%CI:2.278~15.958,P<0.001);在B组患者中,不同的P2Y12抑制剂与其远期预后无明显相关性(P>0.05)。结论携带CYP2C19功能缺陷基因的ACS患者PCI术后选择不同的P2Y12抑制剂与其远期MACE相关,且采用替格瑞洛方案�
Objective To explore the relationship between the selection of different P2Y12 inhibitors and the long-term prognosis of acute coronary syndrome(ACS)patients with and without CYP2C19 defect gene.Method 289 consecutive ACS patients who underwent percutaneous coronary intervention(PCI)at Tianjin Third Central Hospital from March 2016 to October 2016 were selected for CYP2C19 gene polymorphism detection.According to the detection results,the patients were divided into group A(with CYP2C19 loss-of-function gene,199 cases)and group B(without CYP2C19 loss-of-function gene,90 cases).After PCI,different P2Y12 inhibitors were selected.The patients were followed up for 3 years,and 23 cases were lost to follow-up.Finally,182 cases were enrolled in group A and 84 cases were enrolled in group B.According to whether there were major adverse cardiovascular events(MACE)within 3 years,the patients in groups A and B were divided into MACE subgroups(58 cases,32 cases)and non-MACE subgroups(124 cases,52 cases).The single factor analysis of the two subgroups in groups A and B was carried out based on the patient's clinical data,coronary artery disease and intervention status,and postoperative drug treatment plan.Risk factors with statistical significance(P<0.05)were selected,and multivariate logistic regression analysis was performed on groups A and B to compare the effects of different P2Y12 inhibitors on the prognosis of the two groups.Results The differences in platelet volume,fasting blood glucose,HbA1c,left ventricular end-diastolic diameter,proportion of single-branch lesions,proportion of intervention for left main lesions,and dual antiplatelet therapy were statistically significant between the two subgroups in group A(all P<0.05).The differences in low-density lipoprotein(LDL),left ventricular ejection fraction(LVEF),left ventricular end-diastolic diameter,proportion of two-branch lesions,proportion of three-branch lesions,and proportion of using tirofeben were statistically significant between the two subgroups in group B(al
作者
王赟赟
李彤
刘迎午
刘博江
赵杰
赖朝辉
苏斌
赵云
王昭
Wang Yunyun;Li Tong;Liu Yingwu;Liu Bojiang;Zhao Jie;Lai Chaohui;Su Bin;Zhao Yun;Wang Zhao(Heart Center of Tianjin Third Central Hospital,Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases,Artificial Cell Engineering Technology Research Center,Tianjin 300170,China)
出处
《国际生物医学工程杂志》
CAS
2020年第3期207-214,共8页
International Journal of Biomedical Engineering
基金
天津市自然科学基金(19JCYBJC2600)。
