摘要
目的探讨血栓弹力图检测经皮冠状动脉介入术(percutaneous coronary intervention,PCI)术后冠心病患者氯吡格雷药效与细胞色素P450酶等位(CYP2C19)基因型的相关性。方法选取青岛大学附属医院2017年1月至2019年1月收治的冠心病行PCI术后患者187例作为研究对象,根据CYP2C19基因分型和血栓弹力图二磷酸腺苷(ADP)抑制率检测结果分为氯吡格雷敏感组(154例)与氯吡格雷抵抗组(33例)。比较两组患者的二磷酸腺苷最大血块强度(MA-ADP)水平,以及心脏不良事件的发生情况。结果CYP2C19基因快代谢型ADP抑制率高于中间代谢型ADP抑制率,中间代谢型高于慢代谢型ADP抑制率(P<0.05);快代谢型MA-ADP低于中间代谢型MA-ADP,中间代谢型低于慢代谢型MA-ADP(P<0.05);氯吡格雷敏感组患者的不稳定型心绞痛和急性心肌梗死发生率低于氯吡格雷抵抗组(P<0.05)。结论ADP抑制率和MA-ADP与CYP2C19基因型有较好的相关性,且血栓弹力图对PCI术后冠心病患者的氯吡格雷药效监测及指导临床个体化用药均有重要意义。
Objective To investigate the correlation between clopidogrel efficacy and CYP2C19 genotype in patients with coronary heart disease after PCI by thromboelastography.Methods A total of 187 patients with coronary heart disease undergoing PCI admitted to Affiliated Hospital of Qingdao University from January 2017 to January 2019 were selected as study subjects.According to the results of CYP2C19 genotyping and thromboelastic graph ADP inhibition rate detection,they were divided into clopidogre-sensitive group(n=154)and clopidogre-resistant group(n=33).The levels of MA-ADP and the incidence of cardiac adverse events were compared between the two groups.Results The inhibition rate of CYP2C19 gene ADP was higher than that of intermediate metabolism type,and that of intermediate metabolism type was higher than that of slow metabolism type(P<0.05).The fast metabolism type MA-ADP was lower than the intermediate metabolism type MA-ADP,the intermediate metabolism type was lower than the slow metabolism type MA-ADP(P<0.05).The incidence of unstable angina pectoris and acute myocardial infarction in clopidogrel sensitive group was lower than that in clopidogrel resistant group(P<0.05).Conclusion ADP inhibition rate and MA-ADP have good correlation with CYP2C19 genotype.Thromboelastography is of great significance in monitoring clopidogrel efficacy and guiding clinical individualized medication in patients with coronary heart disease after PCI.
作者
孟子凡
李晶
张蓓
MENG Zifan;LI Jing;ZHANG Bei(School of Basic Medicine,Qingdao University,Qingdao,Shandong 266000,China;Affiliated Hospital of Qingdao University,Qingdao,Shandong 266000,China)
出处
《大医生》
2020年第21期112-114,共3页
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