摘要
目的探讨CYP2C19基因多态性检测指导冠状动脉旁路移植术(coronary artery bypass grafting,CABG)后双抗治疗方案的应用价值。方法回顾性分析2015年2月~2022年2月我院166例冠心病行CABG的临床资料,根据患者是否行CYP2C19基因检测及个体化抗血小板,分为个体化治疗组和常规治疗组,前者根据CYP2C19基因检测结果采用阿司匹林联合氯吡格雷或替格瑞洛治疗,后者采用阿司匹林联合标准剂量的氯吡格雷治疗。比较2组主要不良心血管事件(major adverse cardiovascular events,MACE)、出血事件发生情况,以及术后12个月桥血管通畅情况。结果个体化治疗组和常规治疗组患者MACE发生率分别为2.5%(2/80)、10.5%(9/86),差异有统计学意义(χ^(2)=4.250,P=0.039);出血事件发生率分别为16.3%(13/80)、5.8%(5/86),差异有统计学意义(χ^(2)=4.669,P=0.031)。术后1年冠状动脉CTA示个体化治疗组桥血管总体通畅率93.7%(252/269),显著高于常规治疗组85.1%(239/281)(Z=-3.259,P=0.001)。结论基于CYP2C19基因指导下个体化抗血小板治疗方案,可以降低CABG患者术后MACE发生率,提高术后1年桥血管通畅率。
Objective To investigate the value of CYP2C19 gene polymorphism detection in guiding dual antiplatelet therapy of coronary artery disease after coronary artery bypass grafting(CABG).Methods Clinical data of 166 patients with coronary heart disease receiving CABG in our hospital from February 2015 to February 2022 were retrospectively analyzed.According to whether CYP2C19 gene detection and individualized antiplatelet therapy,they were divided into individualized treatment group and routine treatment group.The former was treated with aspirin combined with clopidogrel or ticagrelor based on CYP2C19 gene test results,and the latter with aspirin combined with a standard dose of clopidogrel.The occurrence of major adverse cardiovascular events(MACE),bleeding events,and bridging artery patency at 12 months after surgery were compared between the two groups.Results The incidence of MACE in the two groups was 2.5%(2/80)and 10.5%(9/86),respectively,and the difference was statistically significant(χ^(2)=4.250,P=0.039).There was a statistically significant difference in the incidence of bleeding(χ^(2)=4.669,P=0.031).Coronary artery CTA showed that the overall patency rate of bridging vessels in the individualized treatment group was 93.7%(252/269),significantly higher than that in the conventional treatment group 85.1%(239/281,Z=-3.259,P=0.001).Conclusion Individualized antiplatelet therapy guided by CYP2C19 gene detection can reduce the incidence of postoperative MACE in patients after CABG and improve the bridging patency rate at 1 year after surgery.
作者
丛子涵
张明
吴奇勇
Cong Zihan;Zhang Ming;Wu Qiyong(Depatment of Cardiothoracic Surgery,Changzhou Second People’s Hospital,Changzhou 213000,China)
出处
《中国微创外科杂志》
CSCD
北大核心
2023年第6期442-448,共7页
Chinese Journal of Minimally Invasive Surgery
基金
常州市科学技术局2020年基金(CE20205047)。
