CYP2C19基因多态性指导急性冠脉综合症患者经皮冠脉介入治疗后抗血小板治疗的价值研究  

The Study of CYP2C19 Gene Polymorphisms Screening in Evaluation of Antiplatelet Therapy after PCI in Acute Coronary Syndrome

作　　者：姜阳[1] 董鹏[1] 王立中 李远征 刘芳[1] 

机构地区：[1]航空总医院心内科,北京市100012

出　　处：《中国分子心脏病学杂志》2015年第3期1308-1310,共3页Molecular Cardiology of China

摘　　要：目的本研究旨在探讨急性冠脉综合症(ACS)患者中CYP2C19基因多态性的分布特点,并联合血小板聚集抑制率(IPA)观察不同基因型患者氯吡格雷治疗后主要心血管事件(MACE)的发生率。方法共入选2013年8月至2015年3月在北京朝阳医院、航空总医院住院102例接受经皮冠状动脉介入治疗(PCI)的ACS患者,对所有患者常规进行CYP2C19基因型检测。并于服药后1小时、24小时及1周后抽血,采用血栓弹力图(TEG)检测IPA。按CYP2C19基因多态性分组,随访1月,记录MACE发生情况。结果本组患者中慢代谢型所占比例为13.72%。不同时间点慢代谢型组IPA均显著低于快代谢型组和中间代谢组(P基因型<0.001);慢代谢型组各种MACE事件发生率均显著高于快代谢型组和中间代谢组(P<0.05)。结论 CYP2C19慢代谢基因型患者应用常规剂量氯吡格雷并不能有效预防MACE发生率。建议对择期PCI患者行基因型检测,建议对急诊PCI患者使用其他不受基因型影响的抗血小板药物。Objective To evaluate the CYP2C19 gene polymorphisms screening guided antiplatelet therapy after percutaneous coronary intervention （PCI） in patients with acute coronary syndrome （ACS）. Methods From August 2013 To March 2015,we enrolled 102 ACS patients treated with PCI in Chaoyang Hospital and Aviation General Hospital. All patients were drawn blood for CYP2C19 gene polymorphisms screening. IPA and platelet activity were detected by TEG in 1 hour, 24 hours and one week respectively after taking Clopidogrel. Therefore, the patients were divided into 3 groups according to CYP2C19 genotypes. Clinical data were collected, patients were followed up a month after PCI, and the end points such as MACE were recorded. Results The slow metabolism of patients in this group accounted for 13.72% of all patients. After divided into different subgroups according to different genotypes, IPA in slow metabolism group was significantly lower than that of the normal metabolism group and the intermediary metabolism group （P〈0.001）. MACE events in slow metabolism group were significantly higher than those in other two groups （P〈0.05）. Conclusions Clopidogrel couldn＇t effectively prevent the incidence of MACE for patients with slow metabolism genotype. So CYP2C19 gene polymorphisms should be examed in regular PCI patients. For patients with emergency PCI, other antiplatelet drugs which less affected by CYP2C19 SNP are recommend.

关 键 词：急性冠状动脉综合征 基因多态性 氯吡格雷 

分 类 号：R541.4[医药卫生—心血管疾病]