基于CYP2C19基因多态性的氯吡格雷抵抗早期筛查及精准治疗  

Early Screening and Precise Treatment of Clopidogrel Resistance Based on CYP2C19 Gene Polymorphism

作　　者：刘娜[1] 仵文英[1] 张抗怀[1] 张超英[2] 王娜[1] 王海涛[1] 

机构地区：[1]西安交通大学第二附属医院药学部,西安710004 [2]西安交通大学第二附属医院心内科,西安710004

出　　处：《医药导报》2017年第5期524-528,共5页Herald of Medicine

基　　金：西安交通大学第二附属医院新技术新疗法资助项目

摘　　要：目的依据CYP2C19基因多态性筛查氯吡格雷抵抗患者并制定精准抗血小板治疗方案。方法急性冠状动脉综合征/经皮冠状动脉成形术患者200例,应用焦磷酸测序技术检测CYP2C19基因多态性识别氯吡格雷弱代谢患者,制定氯吡格雷抵抗应对策略,指导临床抗血小板治疗。结果氯吡格雷抵抗患者(包括中间代谢型和慢代谢型)所占比例高达63.5%。中间代谢型患者中将氯吡格雷剂量加倍占41.4%,更换替格瑞洛占20.2%;慢代谢型患者中将氯吡格雷剂量加倍占39.3%,更换替格瑞洛占46.4%。氯吡格雷抵抗患者的个体化抗血小板治疗比例明显提高。结论基于CYP2C19基因多态性制定的氯吡格雷抵抗应对策略初见临床成效。Objective To screen patients with clopidogrel resistance and develop accurate anti-platelet therapy strategies based on CYP2C19 gene polymorphism.Methods A total of 200 patients with acute coronary syndrome/percutaneous coronary angioplasty were selected.The pyrophosphate sequencing technology was using to detect CYP2C19 gene polymorphism for identifying clopidogrel poor metabolizers and guide antiplatelet therapy according to the development of clopidogrel resistance strategies.Results The proportion of patients with clopidogrel resistance （including intermediate metabolizers and slow metabolizers） was about 63.5%.In clopidogrel intermediate metabolizers, 41.4% cases were applied double dosages of clopidogrel and about 20.2% patients were given ticagrelor instead of clopidogrel.For clopidogrel slow metabolizers, approximately 39.3% cases were given doubled dosage of clopidogrel and 46.4% cases were given ticagrelor.Compared with previous data, the proportion of individual treatment of clopidogrel resistance was significantly increased in this study.Conclusion The strategies for the treatment of clopidogrel resistance, which based on the polymorphism of CYP2C19 gene, have been achieved initial success.

关 键 词：氯吡格雷抵抗 CYP2C19 基因多态性 精准治疗 

分 类 号：R973.2[医药卫生—药品] R969.3[医药卫生—药学]