冠心病介入治疗术后服用氯吡格雷患者的CYP2C19基因型与血小板抑制率的关系研究  

Correlation study between CYP2C19 genotype and platelet inhibition rate in patients taking clopidogrel with coronary heart disease after percutaneous coronary intervention

作　　者：付东亮[1] 刘晓飞[1] 彭文华[1] 张虎[1] 杨鹏[1] 程文立[1] 郑金刚[1] 王勇[1] 

机构地区：[1]北京中日友好医院心内科/老年医学中心,100087

出　　处：《中国心血管杂志》2015年第6期434-437,共4页Chinese Journal of Cardiovascular Medicine

摘　　要：目的 探讨服用氯吡格雷的冠心病介入术后患者的CYP2C19基因型与二磷酸腺苷（ADP）诱导的血小板抑制率之间的关系。方法 选取冠心病介入治疗术后服用氯吡格雷的患者500例,根据CYP2C19基因型分为氯吡格雷快、中、慢代谢3组,通过血栓弹力图测定ADP诱导的血小板抑制率;分析3组CYP2C19基因型与血小板抑制率之间的相关性;对患者进行术后6个月的随访,观察心血管不良事件发生率。结果 （1）500例患者中,氯吡格雷快、中、慢代谢3组的人群分布为42.0%、44.8%和13.2%。（2）氯吡格雷快代谢组的血小板抑制率在0~20%、20%~50%、50%~75%和75%~100%的人群分布为1.90%、14.29%、30.00%和53.81%;中代谢组的人群分布为3.57%、17.86%、22.32%和56.25%;慢代谢组的人群分布为7.58%、21.21%、30.30%和40.91%;3组之间ADP诱导的血小板抑制率差异无统计学意义（P〉0.05）。（3）随访6个月,氯吡格雷快、中、慢代谢3组发生心血管缺血事件分别有9、13和4例,3组之间的缺血性心血管事件差异无统计学意义（P〉0.05）。结论 在本组人群中,CYP2C19基因型与氯吡格雷血小板抑制率之间无明显相关性,推测仅通过CYP2C19基因型不能准确预测氯吡格雷抵抗。Objective To explore the correlation between CYP2C19 genotype and the platelet inhibition rate in patients taking clopidogrel with coronary heart disease （CHD） after pereutaneous coronary intervention （PCI）. Methods A total of 500 patients with CHD after PCI were enrolled and divided into 3 groups, as fast, intermediate and slow metabolizer, according to the results of CYP2C19 genetic testing. The ADP-induced platelet inhibition rate was measured by thromboelastography （TEG）. The relationships between CYP2C19 genotype and platelet inhibition rate among 3 groups were analyzed. Cardiovascular event recurrent rates were followed up 6 months after PCI. Results （ 1 ） The distribution of fast, intermediate or slow metabolizer among the 500 patients was 42.0% , 44. 8% and 13.2% , respectively. （2）The population distribution of platelet inhibition rates of 0-20% , 20%-50% , 50%-75% and 75%-100% were 1.90% , 14. 29%, 30.00% and 53.81% in the group of fast metabolizer, 3.57%, 17.86%, 22. 32% and 56. 25% in the group of intermediate metabolizer, and 7.58%, 21.21% , 30. 30% and 40.91% in the group of slow metabolizer. There was no significant difference of the ADP-induced platelet inhibition rates among three groups （P 〉 0. 05 ）. （3）Cardiovascular ischemic events occurred in 9 cases in fast metabolizer group, 13 in intermediate metabolizer group and 4 in slow metabolizer group during 6 months after PCI （ P 〉 0. 05 ）. Conclusions Prediction of clopidogrel resistance can＇t be decided only by CYP2C19 genotype. In these groups of people, none between CYP2C19 genotype and clopidogrel platelet inhibition was significantly correlated.

关 键 词：血管成形术 经腔 经皮冠状动脉 氯吡格雷抵抗 CYP2C19基因多态性 血小板抑制率 

分 类 号：R541.4[医药卫生—心血管疾病]