摘要
目的 分析CYP2C19基因多态性与冠心病患者氯吡格雷抵抗和经皮冠状动脉介入治疗(Percutaneous coronary intervention,PCI)术后预后的关系。方法 纳入滁州市第一人民医院心血管内科于2020年1月至2023年8月收治的317例冠心病患者,均行PCI治疗,术后给予氯吡格雷口服并于5 d后基于最大血小板聚集率评估氯吡格雷反应性,同时检测其CYP2C19基因多态性,氯吡格雷抵抗者双抗方案调整为阿司匹林+替格瑞洛;患者随访截至2024年4月,记录其随访期间主要不良心血管事件(major adverse cardiovascular events,MACE)发生率。对比不同预后患者CYP2C19基因多态性和临床资料差异,运用Logistic分析影响患者PCI术后预后的相关危险因素。结果 317例患者中,113例检出氯吡格雷抵抗。氯吡格雷抵抗者CYP2C19野生型占比较非氯吡格雷抵抗者低,其突变纯合型占比较非氯吡格雷抵抗者高,差异有统计学意义(P<0.05)。患者随访时间8~51个月,中位随访时间27个月。随访期间共51例患者发生MACE。氯吡格雷抵抗+氯吡格雷组MACE发生率较氯吡格雷抵抗+替格瑞洛组、非氯吡格雷抵抗组更高,差异有统计学意义(P<0.05)。Logistic多因素回归模型显示,氯吡格雷抵抗+氯吡格雷、高密度脂蛋白胆固醇<1.04 mmol/L、CYP2C19基因突变杂合型、CYP2C19基因突变纯合型均为影响冠心病患者PCI术后预后的独立危险因素(P<0.05)。结论 CYP2C19基因突变与冠心病患者氯吡格雷抵抗相关,且氯吡格雷抵抗、血脂、CYP2C19基因突变与患者PCI术后预后直接相关,建议考虑替格瑞洛的替代性应用并关注其安全性。
Objective To analyze the relationship between CYP2C19 gene polymorphism and clopidogrel resistance and prognosis after percutaneous coronary intervention(PCI) in patients with coronary heart disease(CHD).Methods 317 CHD patients admitted to the Cardiovascular Department of the First People's Hospital of Chuzhou City from January 2020 to August 2023 underwent PCI and were administered clopidogrel.After 5 days,the clopidogrel reactivity was evaluated based on the maximum platelet aggregation rate,and the CYP2C19 gene polymorphism was detected.Patients identified as clopidogrel resistant had their dual antiplatelet therapy switched to aspirin plus ticagrelor.The patients were followed up until April 2024,the incidence of major adverse cardiovascular events(MACE) was recorded.The polymorphism of CYP2C19 gene and clinical data in patients with different prognosis were compared and the related risk factors affecting the prognosis of patients after PCI were analyzed by Logistic method.Results Clopidogrel resistance was detected in 113 of 317 patients.The proportion of CYP2C19 wild-type patients was lower among clopidogrel-resistant patients compared to non-resistant patients,while the proportion of mutant homozygous patients was higher(P<0.05).The median follow-up duration was 27 months(ranging from 8 to 51 months).During the follow-up period,51 patients developed MACE.The incidence of MACE was significantly higher in the clopidogrel-resistant group continuing clopidogrel than in the clopidogrel-resistant group switched to ticagrelor and the non-resistant group(P<0.05).Logistic multivariate regression model showed that clopidogrel resistance+clopidogrel,high density lipoprotein cholesterol < 1.04 mM,heterozygosity of CYP2C19 gene mutation and homozygosity of CYP2C19 gene mutation were all independent risk factors affecting the prognosis of CHD patients after PCI(P<0.05).Conclusion Mutation of CYP2C19 gene is related to clopidogrel resistance in CHD patients and clopidogrel resistance,blood lipid and mutation of CYP2C19
作者
傅娴
叶三宁
孙京华
范臻
FU Xian(Chuzhou City Vocational College,Chuzhou 239000,Anhui,China)
出处
《牡丹江医学院学报》
2024年第6期94-97,111,共5页
Journal of Mudanjiang Medical University
基金
安徽省高校自然科学研究重点项目(2023AH052842)。
