替格瑞洛和双倍剂量氯吡格雷对CYP2C19基因突变患者经皮冠状动脉介入术后心血管缺血事件发生率影响的比较  

Comparison study of the effects of ticagrelor and a double dose of clopidogrel on the incidence of cardiovascular ischemic events in patients with mutant CYP2C19 after percutaneous coronary intervention

作　　者：林乐健[1] 唐发宽[1] 华宁[1] 唐雪正[1] 邸春霞[1] 田玲[1] 岳清如 LIN Le-Jian;TANG Fa-Kuan;HUA Ning;TANG Xue-Zheng;DI Chun-Xia;TIAN Ling;YUE Qing-Ru(Department of Cardiology,Chinese PLA Hospital No.309,Beijing 100091,China)

机构地区：[1]解放军第309医院心血管内科,北京100091

出　　处：《中华老年多器官疾病杂志》2018年第9期647-651,共5页Chinese Journal of Multiple Organ Diseases in the Elderly

基　　金：解放军第309医院院立课题(2014MS-004)~~

摘　　要：目的观察替格瑞洛和双倍剂量氯吡格雷对CYP2C19基因突变老年患者经皮冠状动脉介入(PCI)术后心血管缺血以及出血事件发生率的影响。方法入选2014年3月至2017年3月在解放军第309医院心血管内科住院并择期行PCI手术的CYP2C19突变型患者,采用随机数字表法将入选患者分为2组:氯吡格雷组和替格瑞洛组,每组120例。氯吡格雷组服用阿司匹林及双倍剂量的硫酸氢氯吡格雷,替格瑞洛组服用阿司匹林以及替格瑞洛。观察患者住院期间和院外12个月随访期间主要不良心血管事件(MACEs)以及出血事件的发生情况。采用SPSS 17.0软件进行数据处理。依据数据类型,组间比较分别采用t检验或χ2检验。结果与氯吡格雷组相比,替格瑞洛组患者的反应时间[(24.2±2.8)vs(15.3±2.4)s]和血凝块形成时间[(13.4±2.6)vs(6.6±1.8)s]显著增高,而最大幅度[(46.2±2.1)vs(69.5±3.2)mm]显著降低,差异均具有统计学意义(P<0.01)。替格瑞洛组患者MACEs发生率显著低于氯吡格雷组[13.3%(16/120)vs 32.5%(39/120),P<0.01];但2组患者出血事件发生率差异无统计学意义(P>0.05)。结论对于CYP2C19基因突变患者,双倍剂量硫酸氢氯吡格雷可以使血小板抑制效果达标,但心血管缺血事件发生率仍然较高;替格瑞洛能够有效减低药物抵抗发生率,进一步改善血小板抑制效果,降低心血管缺血事件发生率。Objective To observe the effects of ticagrelor and a double dose of clopidogrel on the incidence of cardiovascular ischemia and bleeding after percutaneous coronary intervention （PCI） in the elderly patients with mutant CYP2C19. Methods Enrolled in this study were patients with mutant CYP2C19, who underwent PCI in the Department of Cardiology of Chinese PLA Hospital No.309. They were randomly divided into clopidogrel group and ticagrelor group, with 120 in each group. The former took aspirin and a double dose of clopidogrel and the latter aspirin and ticagrelor. Major adverse cardiovascular events （MACEs） and bleeding events were observed during the hospital stay and a follow-up of 12 months. Data were processed using SPSS statistics 17.0. Depending on data type, Student′s t-test or Chi-square test was conducted for the comparison between two groups. Results Compared with the clopidogrel group, the ticagrelor group had significantly higher R-value [（24.2±2.8） vs（15.3±2.4）s] and K-value [（13.4±2.6） vs（6.6±1.8）s], but lower MA [（46.2±2.1） vs（69.5±3.2）mm], the differences being statistically significant （P〈0.01）. The incidence of MACEs in the ticagrelor group was significantly lower than that in the clopidogrel group [13.3%（16/120） vs 32.5%（39/120）, P〈0.01]; however, there was no significant difference in the incidence of bleeding events between two groups （P〉0.05）.Conclusion In the patients with mutant CYP2C19, a double dose of clopidogrel can be effective in platelet inhibition but with high cardiovascular ischemic events; ticagrelor can effectively reduce drug resistance, enhance platelet inhibition, and thus decrease the incidence of cardiovascular ischemic events.

关 键 词：替格瑞洛 硫酸氢氯吡格雷 血栓弹力图 经皮冠状动脉介入治疗 心血管缺血事件 

分 类 号：R543.3[医药卫生—心血管疾病]