CYP2C19基因多态性与氯吡格雷ADP抑制率的关系  

The relationship between CYP2C19 genetic polymorphism and Clopidogrel antiplatelet

作　　者：丁鸭锁 尹春[1] 高广忠[1] 鲁峻[1] 张勤[1] 孙兵 DING Yasuo;YIN Chun;GAO Guangzhong;LU Jun;ZHANG Qin;SUN Bing(Department of Neurosurgery,Jiangsu Taizhou People＇s Hospital of Nantong University,Jiangsu Province,Taizhou 225300,China)

机构地区：[1]南通大学附属泰州市人民医院神经外科,江苏泰州225300

出　　处：《中国医药导报》2018年第26期18-21,共4页China Medical Herald

摘　　要：目的探讨CYP2C19基因多态性与氯吡咯雷二磷酸腺苷(ADP)抑制率之间的关系。方法选取南通大学附属泰州市人民医院神经外科2014年7月~2017年7月颅内宽颈动脉瘤并行支架辅助弹簧圈栓塞的患者63例,均行常规双抗治疗,为阿司匹林100 mg及氯吡格雷75 mg每天口服。利用专用试剂盒测定CYP2C19基因型。本试验中共检测6种亚型(CYP2C19*1/*1(636GG,681GG),CYP2C19*1/*2(636GG,681GA),CYP2C19*2/*2(636GG,681AA),CYP2C19*1/*3(636GA,681GG),CYP2C19*2/*3(636GA,681GA),CYP2C19*3/*3(636AA,681GG)。将6种CYP2C19基因亚型分为快代谢组[CYP2C19*1/*1(636GG,681GG)]、中快代谢组[CYP2C19*1/*2(636GG,681GA),CYP2C19*1/*3(636GA,681GG)]和慢代谢组[CYP2C19*2/*2(636GG,681AA),CYP2C19*2/*3(636GA,681GA),CYP2C19*3/*3(636AA,681GG)]。利用双抗血小板图测定氯吡格雷对血小板的抑制率(ADP抑制率)。结果 6种CYP2C19基因亚型中,CYP2C19*1/*1和CYP2C19*1/*2为主要基因型,占比分别为63.5%和19.0%。其中快代谢组有40例(63.5%),中快代谢组12例(19.0%)及慢代谢组11例(17.5%);将快代谢组与慢代谢组两组ADP抑制率进行比较,差异无统计学意义(P>0.05)。结论通过检测CYP2C19基因型来调整宽颈动脉瘤支架术后的患者氯吡格雷的用量,意义不大,需要通过其他的指标来监测血小板的抑制情况。Objective To explore the relationship between CYP2C19 Genetic Polymorphism and Clopidogrel in antiplatelet. Methods A total of 63 wide-necked intracranial aneurysm patients after stent-assist coiling embolization in the Neurosurgery Department of Jiangsu Taizhou People＇s Hospital of Nantong University were included in the study who took Clopidogrel （75 rag/d） and Aspirin （100 rag/d） orally. Gene chip kits were applied to test CYP2C19 gene types. In this research, six gene sub-types were tested（CYP2C 19＊ 1/＊ 1 （636GG, 681GG）, CYP2C 19 ＊ 1/＊ 2 （636GG, 681GA）, CYP2C19 - 2/＊ 2 （636GG, 681AA）, CYP2C19＊ 1/＊ 3 （636GA, 681GG）, CYP2C19＊ 2/＊ 3 （636GA, 681GA）, CYP2C19＊ 3/＊ 3 （636AA, 681GG）. And they were divided into three subgroups based on the metabolic rate. CYP2C19 ＊ 1/＊ 1 （636GG, 681GG） was in the rapid subgroup. CYP2C19＊ 1/＊ 2 （636GG, 681GA） and CYP2C19＊ 1/＊ 3 （636GA, 681GG） were in the moderate subgroup. CYP2C19＊ 2/＊ 2 （636GG, 681AA）, CYP2C19＊ 2/- 3 （636GA, 681GA） and CYP2C19＊ 3/＊ 3 （636AA, 681GG） were in the slow subgroup. Thrombelastograms were used to test the inhibition rate of platelet. Results CYP2C19 ＊ 1/＊ 1 and CYP2C19 ＊ 1/＊ 2 were the main gene sub-types, occupied 63.5% and 19.0% separately. There were 40 cases in rapid subgroup（63.5%）, 12 cases in moderate subgroup （19.0%） and 11 cases in slow subgroup （17.5%）. There was no statistical difference in the inhibition rate of ADP between rapid subgroup and slow subgroup （P 〉 0.05）. Conclusion It is of little significance to adjust the amount of Clopidogrel in patients with wide-necked aneurysm stent after detecting genetype. Other indicators are needed to monitor the inhibition of plateles.

关 键 词：CYP2C19基因 氯吡格雷 二磷酸腺苷抑制率 

分 类 号：R541.4[医药卫生—心血管疾病]