瑞舒伐他汀和阿托伐他汀对不同基因型急性冠状动脉综合征患者氯吡格雷抗血小板活性的影响  

Effects of rosuvastatin and atorvastatin on antiplatelet activity of clopidogrel in patients with acute coronary syndrome and different CYP2C19 genotypes

作　　者：邢金平[1] 来春林[1] 赵建强[1] 刘晓红[2] 胡长青 冀友瑞[1] 陈福恒[1] 

机构地区：[1]山西省人民医院心内科一区,太原030012 [2]山西省人民医院特需病房,太原030012

出　　处：《中国药物与临床》2017年第12期1734-1736,共3页Chinese Remedies & Clinics

基　　金：山西省科技厅社会发展方面课题(201603D321078)

摘　　要：目的观察瑞舒伐他汀和阿托伐他汀对不同基因型急性冠状动脉综合征患者氯吡格雷抗血小板活性的影响。方法选择200例急性冠状动脉综合征患者接受阿司匹林100 mg/d、氯吡格雷75 mg/d及低分子肝素5 000 U/12 h治疗,5 d后随机分为阿托伐他汀+正常基因组50例,阿托伐他汀+基因突变组50例,瑞舒伐他汀组+正常基因组50例,瑞舒伐他汀组+基因突变组50例。在服用氯吡格雷之前(基线值)、加用他汀类药物之前及服用他汀类药物7 d后,用全血阻抗法分别测定二磷酸腺苷(ADP)(10 mmol/L)诱导的血小板聚集率(PA)。结果 4组基线值无差别,与基线值比较,服用氯吡格雷5 d后和加服他汀类药物治疗7 d后,4组患者PA明显降低,差异有统计学意义(P<0.05);2组分别在不同基因组间的PA差异有统计学意义(P<0.05),不同他汀对同一基因组的PA差异无统计学意义(P>0.05)。结论经细胞色素3A4途径代谢的阿托伐他汀及不经细胞色素3A4代谢的瑞舒伐他汀,对同一基因组的PA活性无影响,对不同基因组患者氯吡格雷抗血小板活性有影响。Objective To determine the effects of rosuvastatin and atorvastatin on the antiplatelet activity of clopidogrel in patients with acute coronary syndrome（ACS） and different CYP2 C19 genotypes. Methods Two hundred ACS patients initially received aspirin 100 mg/d, clopidogrel 75 mg/d and low molecular weight heparin 5 000 U/12 h.Five hours later, they were randomly divided into the atorvastatin ＋ normal genotype group（ n=50）, atorvastatin ＋ mutated genotype group（n=50）, rosuvastatin ＋ normal genotype group（n=50）, and rosuvastatin ＋ mutated genotype group（n=50）. Prior to clopidogrel medication（baseline）, before addition of statins and at 7 days of statin treatment, 10 mmol/L adenosine diphosphate（ADP）-induced platelet aggregation（PA） rate was determined by whole blood impedance method. Results There was no difference in baseline values between the four groups. Compared with baseline, the PA rates at 5 days of clopidogrel treatment and 7 days of additional statin treatment were significantly reduced in the four groups（P〈0.05）. There was a significant difference in PA between rosuvastatin and atorvastatin across different genotypes（P〈0.05） but not within the same genotype（P〉0.05）. Conclusion Atorvastatin metabolized by the cytochrome 3 A4 and rosuvastatin not metabolized by this pathway have different effects on PA activity in patients with different genotypes but not in those with the same genotype.

关 键 词：急性冠状动脉综合征 氯吡格雷 阿托伐他汀 瑞舒伐他汀 血小板聚集率 

分 类 号：R541.4[医药卫生—心血管疾病]