摘要
目的探讨血栓弹力图(TEG)联合CYP2C19检测对急性冠状动脉综合征(ACS)患者经皮冠状动脉介入治疗(PCI)术后抗血小板治疗的指导价值。方法纳入萍乡市人民医院2019年6月至2022年6月拟行PCI治疗的270例ACS患者,遵循患者意愿分为A组(未行检查,n=88)、B组(CYP2C19基因检测,n=98)、C组(TEG联合CYP2C19基因检测,n=84)。A组给予阿司匹林联合氯吡格雷抗血小板治疗;B组根据CYP2C19基因检测结果分为B1组(正常代谢)、B2组(异常代谢),分别给予阿司匹林联合氯吡格雷、阿司匹林联合替格瑞洛治疗;C组根据CYP2C19基因及TGE检测结果分为C1组[正常代谢+氯吡格雷正常反应(NCR)]、C2组[正常代谢+氯吡格雷低反应(LCR)或异常代谢+NCR]、C3组(异常代谢+LCR),分别给予阿司匹林联合氯吡格雷、阿司匹林联合氯吡格雷或替格瑞洛、阿司匹林联合替格瑞洛治疗,C2组治疗1周后再次检测TEG,根据二磷酸腺苷诱导的最大振幅调整治疗方案。所有患者均维持治疗1年,比较三组治疗前后心功能[左室射血分数(LVEF)、左室舒张末期内径(LVEDD)],统计三组PCI术后1年内主要心血管不良事件(MACE)发生率、出血事件及用药不良反应。结果治疗后,三组LVEF均较治疗前升高,LVEDD均较治疗前降低(P<0.05),但组间比较差异无统计学意义(P>0.05)。C组MACE发生率低于B组、A组,且B组MACE发生率低于A组(P<0.05);三组出血事件及不良反应发生率比较,差异无统计学意义(P>0.05)。结论TEG联合CYP2C19检测对ACS患者PCI术后抗血小板治疗的指导价值较高,可降低MACE发生率,且不会增加出血事件和不良反应发生率。
Objective To explore the guiding value of thromboelastography(TEG)combined with CYP2C19 detection for antiplatelet therapy after percutaneous coronary intervention(PCI)in patients with acute coronary syndrome(ACS).Methods 270 ACS patients who planned to undergo PCI treatment at Pingxiang People's Hospital from June 2019 to June 2022 were divided into Group A(without examination,n=88),Group B(CYP2C19 gene testing,n=98),and Group C(TEG combined with CYP2C19 gene testing,n=84)according to the patient's wishes.Group A was treated with aspirin combined with clopidogrel for antiplatelet therapy;Group B was divided into B1 group(normal metabolism)and B2 group(abnormal metabolism)based on the CYP2C19 gene test results,they were treated with aspirin combined with clopidogrel and aspirin combined with ticagrelor,respectively;Group C was divided into C1 group[normal metabolism+normal response to clopidogrel(NCR)],C2 group[normal metabolism+low response to clopidogrel(LCR)or abnormal metabolism+NCR],and C3 group(abnormal metabolism+LCR)based on the CYP2C19 gene and TGE detection results,aspirin combined with clopidogrel,aspirin combined with clopidogrel or ticagrelor,aspirin combined with ticagrelor,and aspirin combined with ticagrelor were administered separately,TEG was tested again after one week of treatment in Group C2,according to the maximum amplitude induced by adenosine diphosphate,the treatment regimen was adjusted;all patients maintained treatment for 1 year.The cardiac function[left ventricular ejection fraction(LVEF),left ventricular end-diastolic diameter(LVEDD)]before and after treatment were compared among the three groups.The incidence of major adverse cardiovascular events(MACE),bleeding events and adverse drug reactions within 1 year after PCI were counted in the three groups.Results After treatment,LVEF increased and LVEDD decreased in all three groups compared to before treatment(P<0.05),but there was no statistical significant difference between the groups(P>0.05).The incidence of MACE in Group C was lo
作者
周吕桢
李清
蔺军
ZHOU Lyuzhen;LI Qing;LIN Jun(Pingxiang People's Hospital,Pingxiang Jiangxi 337000,China)
出处
《药品评价》
CAS
2024年第8期1019-1023,共5页
Drug Evaluation
基金
江西省卫健委科技计划项目(20204370)。
