P2Y12基因多态性与心脑血管病患者氯吡格雷临床疗效相关性的Meta分析  

Association between P2Y12 Genetic Polymorphisms and Clinical Efficacy of Clopidogrel in the Patients with Cardiovascular and Cerebrovascular Diseases: a Meta-analysis

作　　者：刘利龙 崔静茹[1] 宋佳[1] 吴禹蒙[1] 

机构地区：[1]哈尔滨医科大学附属第四医院药学部,哈尔滨150001

出　　处：《中国药师》2017年第11期1999-2003,共5页China Pharmacist

摘　　要：目的:采用Meta分析方法评价P2Y12基因多态性与心脑血管病患者氯吡格雷疗效及发生氯吡格雷抵抗的相关性。方法:计算机检索MEDLINE、Embase、中国知网、中文生物医学文献数据库、万方数据库(时间为1995年1月~2016年12月),全面收集有关血小板膜受体P2Y12基因多态性与发生氯吡格雷抵抗相关性的队列研究,纳入研究的受试者均为服用氯吡格雷的心脑血管疾病患者,排除动物实验研究,并对可纳入的研究进行严格的方法学质量评价,采用RevMan 5.1软件进行Meta分析。结果:最终纳入10篇队列研究(英文3篇,中文7篇),共5 223名受试者。Meta分析结果显示,使用氯吡格雷的心脑血管病患者中,C34T位点T等位基因携带者与CC型相比,发生不良心血管事件的风险的差异无统计学意义(RR=0.95,95%CI:0.82~1.09,P=0.46);G52T位点T等位基因携带者发生不良心血管事件的风险高于GG型患者,差异有统计学意义(RR=1.99,95%CI:1.63~2.44,P<0.000 01)。C34T位点T等位基因携带者发生氯吡格雷抵抗的风险高于CC型患者,差异有统计学意义(RR=2.02,95%CI:1.37~2.96,P=0.000 4)。G52T位点T等位基因携带者发生氯吡格雷抵抗的风险高于GG型患者,差异有统计学意义(RR=1.56,95%CI:1.04~2.34,P=0.03)。i-T744c位点C等位基因携带者发生氯吡格雷抵抗的危险与C等位基因非携带者相当,差异无统计学意义(RR=0.99,95%CI:0.78~1.25,P=0.92)。结论:C34T位点T等位基因可能是发生氯吡格雷抵抗的危险因素,G52T位点T等位基因可能是不良心血管事件和发生氯吡格雷抵抗的危险因素,i-T744c位点C等位基因的存在不会增加发生氯吡格雷抵抗的风险。Objective： To systematically review the association between P2Y12 genetic polymorphisms and the clinical safety of clopidogrel in the patients with cardiovascular and cerebrovascular diseases. Methods： Retrieved from MEDLINE, Embase, CNKI, SinoMed and Wanfang Database （from January 1995 to December 2016）, array researches about the association between P2Y12 genetic polymorphisms and the clinical safety of clopidogrel were collected including the studies of patients taking clopidogrel with cardiovascular and cerebrovascular diseases and excluding animal experimental studies. The bias of recruited studies was assessed and meta-analy- sis was performed by RevMan 5.1 software. Results： Totally 10 array researches （3 in English and 7 in Chinese） were enrolled involving 5 223 patients. There were no statistical differences between T allele gene carriers and CC genetype patients of C34T in the inci- dence of adverse cardiovascular events （RR =0.95, 95% CI： 0. 82-1.09, P = 0.46）. The incidence of adverse cardiovascular events in T allele gene carriers of G52T was higher than that in GG genetype patients （RR = 1.99, 95% CI： 1.63-2.44, P 〈 0.000 01 ）. The incidence of clopidogrel resistance in T allele gene carriers of C34T was higher than that in CC genetype patients （ RR = 2.02, 95% CI： 1.37-2.96, P =0.000 4）. The incidence of clopidogrel resistance in T allele gene carriers of G52T was higher than that in GG gene- type patients （RR = 1.56, 95% CI： 1.04-2.34, P = 0.03 ）. There was no statistical difference in the risk of clopidogrel resistance between C allele gene carriers of i-T744c and T allele gene no-carriers （RR =0.99, 95% CI：0. 78-1.25, P =0.92）. Conclusion： T allele gene carriers of C34T might be a risk factor of the occurrence of clopidogrel resistance, T allele gene carriers of G52T might be a risk factor of the occurrence of cardiovascular events and clopidogrel resistance, and C allele gene carriers of i-T744c might not increase the danger of the occurrence of c

关 键 词：P2Y12 基因多态性 氯吡格雷 氯吡格雷抵抗 

分 类 号：R968[医药卫生—药理学]