CYP2C19基因多态性与复方丹参滴丸治疗老年冠状动脉粥样硬化性心脏病临床疗效相关性的研究  

Correlation between CYP2C19 gene polymorphism and clinical efficacy of compound danshen dropping pills in treatment of senile coronary atherosclerotic heart disease

作　　者：郭继红 耿小勇 Guo Jihong;Geng Xiaoyong(Qinhuangdao Branch of North China University of Science and Technology, Qinhuangdao 066000, Hebei, China;Department of Cardiology, the Third Hospital of Hebei Medical University, Shijiazhuang 050051, Hebei, China)

机构地区：[1]华北理工大学秦皇岛分院,河北秦皇岛066000 [2]河北医科大学第三医院心内科,河北石家庄050051

出　　处：《中国中西医结合急救杂志》2018年第6期586-589,共4页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：河北省医学科学研究重点课题计划(ZD20140004).

摘　　要：目的研究CYP2C19基因多态性与复方丹参滴丸治疗老年冠状动脉粥样硬化性心脏病(冠心病)临床疗效的相关性,为临床合理用药提供理论依据。方法选择河北医科大学第三医院2015年6月至2017年12月收治的206例老年冠心病患者进行基因型检测分类。所有患者均口服复方丹参滴丸,每次10粒、每日3次,连续治疗2个月。治疗前后均进行血清学指标检测、心电图监测、肝肾功能检测,评价药物疗效和不良反应。结果中代谢型(IM)老年冠心病患者服用复方丹参滴丸2个月后疗效较慢代谢型(PM)和快代谢型(EM)显著〔临床疗效:95.6%(87/91)比80.5%(33/41)、93.2%(69/74),心电图疗效:95.6%(87/91)比78.0%(32/41)、94.6%(70/74)〕,同时血清三酰甘油(TG)、高密度脂蛋白(HDL)含量也较PM和EM型升高〔TG(mmol/L):1.33±0.52比1.33±0.41、1.33±0.27,HDL(mmol/L):1.58±1.17比1.44±0.65、1.38±0.18〕,总胆固醇(TC)、低密度脂蛋白(LDL)、超敏C-反应蛋白(hs-CRP)含量均较PM和EM型降低〔TC(mmol/L):3.48±0.25比3.56±0.96、3.51±0.51,LDL(mmol/L):2.19±0.35比2.23±0.49、2.21±0.87,hs-CRP(mg/L):3.50±1.07比3.53±1.51、3.54±2.01〕。EM、IM型不良反应发生率较PM型明显降低〔6.8%(5/74)、9.9%(9/91)比31.7%(13/41)〕,差异有统计学意义(P<0.05)。结论CYP2C19基因多态性与老年冠心病关系密切,IM型老年患者服用复方丹参滴丸疗效显著,不良反应发生率低。因此老年冠心病患者在临床用药过程中需进行基因检测,充分考虑CYP2C19基因多态性的影响,采用个性化治疗,增效减毒。Objective To study the correlation between the polymorphism of CYP2C19 gene and the clinical efficacy of compound Danshen dripping pills in treatment of senile coronary atherosclerotic heart disease (CHD) and to provide theoretical basis for rational drug use. Methods Two hundred and six elderly patients with CHD treated in the Third Hospital of Hebei Medical University from June 2015 to December 2017 were screened for genotype detection and classification. All patients were given oral compound Danshen dripping pills, 10 pills each time, 3 times a day, for consecutive 2 months. Serological indexes, electrocardiograph (ECG) monitoring, liver and kidney function testing were performed before and after treatment to evaluate drug efficacy and adverse reactions. Results In senile patients with CHD, after taking compound danshen dripping pills for 2 months, the efficacy in patients with intermediate metabolizer (IM) was more significantly effective than the efficacies of the patients with extensive metabolizer (EM) and poor metabolizer (PM) [clinical efficacy: 95.6% (87/91) vs. 80.5% (33/41), 93.2% (69/74), ECG efficacy: 95.6% (87/91) vs. 78.0% (32/41), 94.6% (70/74)], at the same time, the serum levels of triglyceride (TG) and high-density lipoprotein (HDL) in patients with IM were also higher than those in patients with PM and EM [TG (mmol/L): 1.33±0.52 vs. 1.33±0.41, 1.33±0.27, HDL (mmol/L): 1.58±1.17 vs. 1.44±0.65, 1.38±0.18], and the levels of total cholesterol (TC), low-density lipoprotein (LDL) and hypersensitive C-reactive protein (hs-CRP) were lower than those of PM and EM [TC (mmol/L): 3.48±0.25 vs. 3.56±0.96, 3.51±0.51, LDL (mmol/L): 2.19±0.35 vs. 2.23±0.49, 2.21±0.87, hs-CRP (mg/L): 3.50±1.07 vs. 3.53±1.51, 3.54±2.01]. The incidences of adverse reactions in patients with EM and IM were significantly lower than the incidence of PM [6.8% (5/74), 9.9% (9/91) vs. 31.7% (13/41)], the differences being statistically significant (both P < 0.05). Conclusions CYP2C19 gene polymorphism is closely relat

关 键 词：复方丹参滴丸 CYP2C19基因多态性 冠心病 增效减毒 

分 类 号：R541.4[医药卫生—心血管疾病]