急性冠脉综合征合并糖尿病PCI患者CYP2C19基因多态性与替格瑞洛疗效的相关性  

Correlation between efficacy of Ticagrelor and CYP2C19 gene polymorphism in patients with diabetes mellitus complicated with acute coronary syndrome receiving PCI

作　　者：梁茜[1] 王蔚[1] 杨希立[1] 李炜杰 许兆延[1] 

机构地区：[1]广东省佛山市第一人民医院心血管内科,528000

出　　处：《实用医学杂志》2017年第19期3276-3280,共5页The Journal of Practical Medicine

基　　金：2014年佛山市医学类科技攻关项目基金(编号:2014AB00274)

摘　　要：目的通过对急性冠脉综合征(ACS)合并糖尿病(DM)行冠脉介入术(PCI)患者进行研究,采用聚PCR RFLP法进行CYP2C19基因型检测,评价替格瑞洛对CYP2C19基因多态性患者的疗效。方法选取494例患有ACS合并DM行PCI术的患者,分为常规治疗组与个体治疗组,常规治疗组给予阿司匹林0.1 g/d联合氯吡格雷75 mg/d;个体治疗组采用聚PCR RFLP法进行CYP2C19基因型检测,携带野生型基因(*1/*1)归为快代谢型,突变杂合型(*1/*2、*1/*3)为中间代谢型、突变纯合型(*2/*2、*2/*3、*3/*3)为慢代谢型。快代谢型给予阿司匹林0.1 g/d联合氯吡格雷75 mg/d,中间代谢型及慢代谢型给予拜阿司匹林0.1 g/d联合替格瑞洛90 mg每天2次,所有患者服用双联抗血小板聚集药物持续时间12个月。观察两组患者不良心血管事件、出血等不良反应的发生率。结果常规治疗组其出现心源性死亡、再发心肌梗死及心绞痛、支架内血栓、脑卒中及靶血管血运重建的发生率明显高于个体治疗组(P<0.05),在出血风险方面,主要出血及次要出血发生率在两组患者之间无差异(P>0.05),最小出血发生率以个体治疗组的中间代谢型稍高,但与快代谢型及慢代谢型组相比差异无统计学意义(P>0.05)。结论 ACS合并DM患者在PCI术后使用替格瑞洛抗血小板聚集的疗效不受CYP2C19基因多态性的影响,且不增加12个月内出血风险。Objective To study the CYP2C19 genotype in patients with acute coronary syndrome （ACS） complicated with diabetes mellitus （DM） receiving percutaneous coronary intervension （PCI） by polymerase chain reaction （PCR）, and to evaluate the efficacy of Ticagrelor in CYP2CI9 gene polymorphism. Methods A total of 494 ACS patients with DM were enrolled. The patients were divided into routine treatment group and individual treatment group. Routine treatment group received 0.1 g/d aspirin/d and 75 mg/d of Clopidogrel. CYP2C19 gene polymorphism was examined in individual treatment group. （＊1/＊1） was classified into fast metabolic type, mutant heterozygous type （ ＊1/＊2, ＊1/＊3 ） into intermediate metabolic type and mutant pure type （ ＊2/＊2, ＊2/＊3, ＊3/＊3 ） into slow metabolic type. Fast metabolic type received aspirin 0.1 g/d and Clopidogrel 75 mg/d, and intermediate and slow metabolic type received aspirin 0.1 g/d and Ticagrelor 90 mg bid for 12 months or more to observe the inci- dence of adverse cardiovascular events, bleeding and other adverse reactions in 2 groups. Results The incidence of cardiac death, recurrent myocardial infarction and angina pectoris, stroke, stent thrombosis and target vessel revascularization in routine treatment group was significantly higher than that in individual treatment group （P 〈 0.05）. There was no significant difference between two groups in terms of major bleeding and secondary bleeding （P 〉 0.05 ）. The minimum bleeding rate was slightly higher in intermediate metabolic type in individual treatment group but without significantly difference when compared with that in fast metabolic type and slow metabolic type （both P 〉 0.05）. Conclusion Without elevating the risk of bleeding within 12 months, the efficacy of Ticagrelor is not affected by CYP2C19 gene polymorphism in patients with ACS complicated with DM after PCI.

关 键 词：糖尿病 急性冠状动脉综合征 CYP2C19基因多态性 替格瑞洛 

分 类 号：R541.4[医药卫生—心血管疾病] R587.1[医药卫生—内科学]