CYP2C19基因多态性与血小板抑制率及氯吡格雷低反应性的关系  

Correlations of CYP2C19 gene polymorphism with platelet inhibitionrate and clopidogrel low responsiveness

作　　者：王豪 张晓[1] 朱记法[1] 邢军辉[1] 

机构地区：[1]郑州大学第一附属医院心血管内科,郑州450002

出　　处：《实用医学杂志》2018年第1期128-131,共4页The Journal of Practical Medicine

基　　金：河南省高等学校重点科研项目计划基金资助(编号:16A320027)

摘　　要：目的探讨经皮冠状动脉介入(PCI)治疗围手术期服用氯吡格雷患者的CYP2C19基因型多态性与血小板抑制率及氯吡格雷药物低反应性的关系。方法搜集2016年2月至2017年2月行PCI治疗服用氯吡格雷的患者404例,根据CYP2C19基因型分为快代谢、中等代谢、慢代谢3组,通过血栓弹力图检测二磷酸腺苷(ADP)诱导的血小板抑制率,血小板抑制率<30%定义为氯吡格雷低反应性,分析CYP2C19基因型与血小板抑制率及氯吡格雷低反应性之间的关系。结果 (1)404例患者中快、中、慢代谢型三组的分布为45.5%、45.3%、9.2%。3组间一般资料(年龄、性别、血小板、高血压病、糖尿病、高脂血症)差异无统计学意义(P>0.05)。(2)3组间血小板抑制率差异无统计学意义(P=0.312)。(3)3组间氯吡格雷低反应性差异无统计意义(P=0.295),其中快代谢组与中等代谢组比较差异无统计学意义(P=0.522),快代谢组和慢代谢组比较差异无统计学意义(P=0.117),中等代谢组和慢代谢组比较差异无统计学意义(P=0.255)。结论 PCI治疗服用氯吡格雷患者的CYP2C19基因型与血小板抑制率及氯吡格雷低反应性之间无相关性,仅检测CYP2C19基因型并不能准确预测氯吡格雷抗血小板作用的强弱。Objective To investigate the relationships of CYP2C19 genotype polymorphism with platelet inhibition rate and clopidogrel low responsiveness in patients taking percutaneous coronary intervention （PCI） during perioperative administration of clopidogrel. Methods 404 patients taking clopidogrel after PCI were included from Fehruary 2016 to February 2017. They were divided into three groups fast metaboliszer, moderate metaboliszer and slow metabolizer, according to the CYP2C19 genotype. Platelet inhibition rate induced by adenosine diphos-phate （ADP） was detected by thrombelastogram, platelet inhibition rate 〈 30% was defined as clopidogrel low re- sponsiveness （CLR） group and the relationships between the three groups were analyzed in view of CYP2C19 genotype and the platelet inhibition rate and the clopidogrel low responsiveness. Results （ 1 ） The proportions of the three groups was 45.5%, 45.3% and 9.2% in the 404 patients, no statistically significant difference among the three groups in general data （age, sex, platelet, hypertension, diabetes mellitus, hyperlipidemia） （P 〉 0.05）. （2） There was no statistically significant difference in the platelet inhibition rate between the three groups （P = 0.312）. （3） There was no significant difference in the clopidogrel low responsiveness between the three groups （P = 0.295 ）, with the fast metabolizer group vs. intermediate metabolizer （P = 0.522）, the fast metabolizer group vs. the slow metabolizer （P = 0.117） and the intermediate metabolizer group vs. slow metabolizer （P = 0.255）. Conclusion There is no correlation of CYP2C19 genotype with platelet inhibition rate and clopidogrel low respon- siveness in patients taking clopidogrel after PCI. Only the detection of CYP2C19 genotype may not accurately pre- dict the antiplatelet aggregative activity of clopidogrel.

关 键 词：CYP2C19基因型 血栓弹力图 血小板抑制率 氯吡格雷低反应性 

分 类 号：R54[医药卫生—心血管疾病]