沈阳地区冠心病患者氯吡格雷药物代谢相关CYP2C19基因多态性分布分析  

Analysis of polymorphism distribution of clopidogrel metabolism related gene CYP2C19 in patients with coronary artery disease in Shenyang area

作　　者：赵连爽[1] 杨紫伟[1] 代娣[1] 郭晓临[1] 

机构地区：[1]中国医科大学附属第一医院检验科,沈阳110001

出　　处：《检验医学与临床》2017年第6期754-755,758,共3页Laboratory Medicine and Clinic

基　　金：国家卫生和计划生育委员会课题(201402018)

摘　　要：目的分析沈阳地区冠心病患者细胞色素P4502C19(CYP2C19)基因型的分布情况。方法选取2013年4月至2015年12月在该院进行经皮冠状动脉支架术(PCI)的冠心病患者2 601例为研究对象。采用聚合酶链反应微阵列基因芯片法检测氯吡格雷代谢相关的酶CYP2C19*1,*2,*3等位基因,其中CYP2C19*1编码正常酶活性。根据患者携带的CYP2C19等位基因不同,将患者分为不同氯吡格雷代谢型,其中快代谢型为(*1/*1)、中代谢型为(*1/*2、*1/*3),慢代谢型(*2/*2、*3/*3、*2/*3)。结果沈阳地区冠心病患者CYP2C19基因型分布由多到少分别为*1/*2、*1/*1、*2/*2、*1/*3、*2/*3及*3/*3,分别占患者总数的40.0%、39.1%、9.8%、7.4%、3.6%和0.1%;不同性别在CYP2C19基因型上分布比较,差异无统计学意义(χ~2=5.718,P=0.335);氯吡格雷快、中、慢代谢型分别占39.1%、47.4%和13.6%,不同代谢型中性别分布比较,差异无统计学意义(χ~2=2.310,P=0.315);不同年龄段患者氯吡格雷代谢型分布比较,差异无统计学意义(χ~2=11.543,P=0.317)。结论沈阳地区冠心病拟行PCI患者中约60%携带CYP2C19*2、*3功能缺失基因,但与性别无关,建议PCI术后个体化使用氯吡格雷抗血小板聚集治疗。Objective To analyze the genotype distribution of cytochrome P4502C19（CYP2C19） in the patients with coronary heart disease（CHD） in Shenyang area. Methods A total of 2 601 patients with CHD receiving percutaneous coronary artery stent （PCI） in our hospital from April 2013 to December 2015 were selected as the research subjects. The PCR microarray gene chip was used to detect the clopidogrel metabolism enzymes related CYP2C19 ＊ 1, ＊ 2 ＊ 3 allele,in which CYP2C19 ＊ 1 encoded normal enzyme activity. According to different CYP2C19 alleles, the patients were divided into different types of clopidogrel metabolism, including the extensive metabolizers （EM, ＊ 1/＊ 1 ）, intermediate metabolizers （IM, ＊ 1/＊ 2, ＊ 1/＊ 3）, poor metabolizers （PM, ＊ 2/＊ 2, ＊ 3/＊ 3, ＊ 2/＊ 3）. Results The distribution of CYP2C19 genotype in CHD patients in Shenyang area from more to less was ＊ 1/＊ 2, ＊ 1/＊ 1, ＊2/＊2, ＊ 1/＊3, ＊2/＊ 3 and ＊ 3/＊ 3 respectively, accounting for 40.0%,39.1%,9.8%,7.4%,3.6 %and 0.1% of the total number of patients; there was no statistically significant difference in gender（χ^2 = 5.718, P = 0.335）. EM, IM and PM clopidogrel metabolic type accounted for 39.1%, 47.4 % and 13.6 % respectively, there was no statistical difference in gender（χ^2=2. 310, P = 0. 315）. There was no statistical difference in clopidogrel metabolic type among different age groups （χ^2= 11. 543,P=0. 317）. Conclusion About 60%of CHD patients undergoing PCI carry CYP2C19 ＊ 2, ＊ 3 afunctional gene,but which has no relation to gender,it is suggested that clopidogrel can be used in individualized treatment against platelet aggregation after PCI.

关 键 词：冠心病 氯吡格雷 细胞色素P4502C19基因型 基因多态性 

分 类 号：R969[医药卫生—药理学]