摘要
目的:探讨CYP2C19基因检测对急性冠脉综合征(ACS)经皮冠状动脉介入治疗(PCI)患者术后氯吡格雷用药的指导作用。方法:入选2016年1月至2018年12月入住郑州中心医院心血管内科ACS并行PCI采用药物洗脱支架植入的患者787例为研究对象,进行前瞻性队列研究,按是否进行CYP2C19基因检测,分为氯吡格雷组(A组)、氯吡格雷基因导向组(B组)和替格瑞洛组(C组),B组按基因型划分为超快和快代谢型(B1组)、中间代谢型(B2组)、慢代谢型(B3组)。所有患者均采用双抗疗法,用药至术后1年。3组在PCI术前、术后检测血清中hs-CRP、IL-6、TNF-α水平和血小板聚集率,并随访记录患者术后1年内主要心脑血管事件、出血事件和有关的不良反应,评价有效性和安全性。结果:B、C组术后24 h及7 d的hs-CRP、IL-6和TNF-α水平均显著低于A组(P<0.05)。B1、B2、B33组患者术后24 h及7 d的hs-CRP、IL-6和TNF-α水平均无显著差异(P>0.05)。B、C 2组术后血小板聚集率均显著低于A组(P<0.05)。对抗血小板聚集药物的正常反应型和无反应型在A、B、C 3组间均差异显著(P<0.05),药物各反应型在B1、B2和B33组间均无显著差异(P<0.05)。A、B、C 3组间次要终点事件和出血事件发生率均差异显著(P<0.01),且A组次要终点事件及血运重建率均显著高于B组和C组(P<0.05),C组小出血事件发生率、发生气短、气促或呼吸抑制的发生率分别明显高于A组和B组(P<0.05)。结论:CPY2C19基因检测指导ACS经PCI患者的氯吡格雷用药,可显著降低炎性因子水平,抑制血小板聚集,显著降低次要不良事件发生率,具有临床意义。
OBJECTIVE To explore the role of CYP2C19 gene detection in the treatment of clopidogrel in patients with acute coronary syndrome(ACS)after percutaneous coronary intervention(PCI).METHODS A prospective cohort study was conducted for 787 patients with ACS and PCI using drug-eluting stent implantation from January 2016 to December 2018.They were divided into the groups of clopidogrel(A),gene-directed clopidogrel(B)and tegrilol(C)according to whether or not there was consent to CPY2C19 gene test.Group B was divided into super fast and fast metabolism type(group B1),intermediate metabolism type(group B2)and slow metabolism type(group B3)according to CYP2C19 genotype.Dual antiplatelet therapy was offered until one year post-operation.Group B was treated according to CYP2C19 genotype.The levels of hs-CRP,IL-6,TNF-αand platelet aggregation rate were measured before and after PCI.The major adverse cardiovascular events,bleeding events and related adverse reactions were recorded by telephone follow-up at one year after PCI and efficacy and safety were evaluated.RESULTS The levels of hs-CRP,IL-6 and TNF-αwere significantly lower in groups B and C than those in group A(P<0.05).No significant differences existed in the levels of hs-CRP,IL-6 and TNF-αamong groups B1,B2 and B3 for 24 h and 7 days after PCI(P>0.05).The platelet aggregation rate was significantly lower in group B/C than that in group A(P<0.05).Significant difference existed in normal reactive type and non-reactive type of antiplatelet aggregation drugs among groups A,B and C(P<0.05).No significant difference existed in reaction type of antiplatelet aggregation drugs among groups B1,B2 and B3(P>0.05).Significant differences existed in the incidence of secondary end point events and bleeding events among groups A,B and C(P<0.01)and the incidence of secondary endpoint events and revascularization were significantly higher in group A than those in group B/C(P<0.05).The incidence of small bleeding events,dyspnea or respiratory suppression in group C was significant
作者
周丽娟
曹巍
詹峰
申明慧
梁茜茜
李敏
任斌
ZHOU Li-juan;CAO Wei;ZHAN Feng;SHEN Ming-hui;LIANG Qian-qian;LI Min;RIN Bin(Translational Medicine Center,Affiliated Central Municipal Hospital,Zhengzhou University,Henan Zhengzhou 450007,China;Department of Pharmacy,Affiliated Central Municipal Hospital,Zhengzhou University,Henan Zhengzhou 450007,China;Department of Science&Education,Affiliated Central Municipal Hospital,Zhengzhou University,Henan Zhengzhou 450007,China;Emergency Intensive Care Unit,Affiliated Central Municipal Hospital,Zhengzhou University,Henan Zhengzhou 450007,China)
出处
《中国医院药学杂志》
CAS
北大核心
2021年第4期383-389,共7页
Chinese Journal of Hospital Pharmacy
基金
2020年河南省高等学校重点科研项目计划(编号:20B350008)
河南省教育厅重点项目资助(编号:16A310033)
2019年河南省医学科技攻关计划联合共建项目(编号:LHGJ20191056)。
