CYP2C19基因多态性与介入治疗后氯吡格雷药物疗效的相关性研究  

Correlation between CYP2C19 polymorphism and effect of clopidogrel on CYP2C19 mutation in patients after PCI

作　　者：唐发宽[1] 林乐健[1] 华宁[1] 陆宏[1] 唐雪正[1] 张卫华[1] 

机构地区：[1]解放军309医院心血管内科,北京100091

出　　处：《中华老年心脑血管病杂志》2012年第9期911-914,共4页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

摘　　要：目的探讨PCI术后CYP2C19基因多态性与不同剂量氯吡格雷药物效果的相关性。方法通过基因芯片检测技术,筛选PCI术后CYP2C19基因突变为CYP2C19*2/*2、CYP2C19*2/*3或CYP2C19*3/*3的患者67例,随机分为常规组22例、2倍组22例和3倍组23例。常规组75 mg氯吡格雷、2倍组150 mg氯吡格雷、3倍组225 mg氯吡格雷,1次/d。分别于PCI术后1、3、6个月通过血栓弹力图检测各组氯吡格雷药物抑制率及再发心血管缺血事件发生率。结果 PCI术后6个月内,2倍组和3倍组患者心血管缺血事件发生率较常规组明显降低(81.8%vs 31.8%vs 21.7%,P<0.01),2倍组与3倍组比较差异无统计学意义(P>0.05)。术后1、3、6个月2倍组和3倍组氯吡格雷药物抑制率较常规组显著升高(P<0.01),2倍组与3倍组比较差异无统计学意义(P>0.05)。3组出血风险比较差异无统计学意义(P>0.05)。结论 CYP2C19基因变异患者增加氯吡格雷药物服用剂量,可在一定程度上提高血小板的抑制,降低心血管缺血事件发生率,且不增加出血事件的发生率。Objective To study the correlation between CYP2C19 polymorphism and effect of clo- pidogrel on CYP2C19 mutations in patients after PCI. Methods Sixty-seven patients with CYP2C19 ＊2/＊ 2,CYP2C19 ＊ 2/＊ 3 or CYP2C19 ＊ 3/＊ 3 mutations detected with gene chip de- tection technology after PCI were randomly divided into routine dose group（n：22）,2-fold dose group（n：22） and 3-fold dose group（n：23）. Patients in the 3 groups were given 75 rag,150 mg and 225 mg of clopidogrel respectively,once a day. Clopidogrel inhibitory rate and cardiovascular ischemic event recurrent rate were assayed 1,3 and 6 months after PCI according to the throm- boelastography. Results The incidence of cardiovascular ischemic events was significantly lower in 2-fold and 3-fold dose groups than in routine dose group 6 months after PCI（81.8% vs 31.8% vs 21.7%,P〈0. 01） with no significant difference between 2-fold and 3-fold dose groups（P〉 0.05）. The clopidogrel inhibitory rate for cardiovascular ischemic events was significantly higher in 2-fold and 3-fold dose groups than in routine dose group 1,3 and 6 months after PCI（P〈0.01） with no significant difference between 2-fold and 3-fold dose groups （P〉0.05）. No significant difference was found in bleeding risk among the 3 groups（P〉0.05）. Conclusion Increasing the dose of clopidogrel increases its inhibitory effect on platelets, reduces the incidence of recurrent cardiovascular ischemic events and dose not increase the incidence of bleeding events in patients with CYP2C19 mutations.

关 键 词：突变 血小板聚集 血小板聚集抑制剂 血小板糖蛋白GP Ⅱb-Ⅲa复合物 等位基因 阿司匹林 细胞色素 P450酶系统 血栓弹力描记术 

分 类 号：R541.4[医药卫生—心血管疾病]