CYP2C19基因多态性对冠心病PCI术后氯吡格雷抵抗的影响及替代治疗方案的比较  

Effect of CYP2C19 gene polymorphism on clopidogrel resistance after PCI in coronary heart disease and comparison of alternative treatment options

作　　者：郭亚娜[1] 蒋翠霞[1] 杜金红[1] 王静珠 齐林[1] GUO Yana;JIANG Cuixia;DU Jinhong;WANG Jingzhu;QI Lin(Zhengzhou 7th people's Hospital,450006,China)

机构地区：[1]郑州市第七人民医院,河南郑州450006

出　　处：《实验与检验医学》2018年第6期821-823,842,共4页Experimental and Laboratory Medicine

基　　金：郑州市科技计划项目;编号:郑科20160109

摘　　要：目的探讨CYP2C19基因多态性对冠心病经皮冠状动脉介入(PCI)术后抗血小板治疗的影响及替代治疗方案的选择。方法选取2016年4月至2017年4月在我院治疗的冠心病患者90例,采用PCR扩增片段长度多态性检测患者CYP2C19基因型分布,散射比浊法检测血小板聚集率;将氯吡格雷抵抗(CR)患者随机分为氯吡格雷双倍剂量组(150mg/d,1个月后减量为75mg/d)和替格瑞洛组(90mg/d,每日2次),观察两组治疗后血小板抑制率和不良心血管事件发生率。结果 90例患者中,CYP2C19~*1/~*1患者28例,CYP2C19~*1/~*2患者48例,CYP2C19~*2/~*2患者8例,CYP2C19~*2/~*3患者6例;野生型组CR发生比例为21.43%,明显低于非野生型组的66.13%(P<0.05);替格瑞洛组术后12个月血小板抑制率为(55.03±9.10)%,明显高于氯吡格雷双倍剂量组(P<0.05);替格瑞洛组术后12个月不良心血管事件发生率为0.00%,明显低于氯吡格雷双倍剂量组的24.00%,差异比较有统计学意义(P<0.05)。结论 CYP2C19基因多态性与冠心病PCI术后氯吡格雷抵抗有关;氯吡格雷抵抗患者应用替格瑞洛具有较好的效果。Objective To investigate the effect of CYP2C19 gene polymorphism on antiplatelet therapy after percutaneous coronary intervention(PCI)and the choice of treatment regimen.Methods A total of 90 patients with coronary heart disease in our hospital from April 2016 to April 2017 were selected,the distribution of CYP2C19 genotype was detected after amplification of fragment length polymorphism by PCR,and platelet aggregation rate was detected;The clopidogrel resistance(CR)patients were randomly divided into the double dose of clopidogrel group(150mg/d,75mg/d after one months)and the ticagrelor group(90mg,2 times a day),platelet inhibition rate and incidence of adverse cardiovascular events after treatment were observed in the two groups.Results Out of the 90 patients,28 were CYP2C19*1/*1,48 were CYP2C19*1/*2,8 were CYP2C19*2/*2,and 6 were CYP2C19*2/*3;The incidence of CR in wild type group was 21.43%,which was significantly lower than that in non wild group 50.00%(P<0.05);The platelet inhibition rate at postoperative 12 months in ticagrelor group was(55.03±9.10)%,was significantly higher than that in the clopidogrel double dose group(P<0.05);The incidence of adverse cardiovascular events at postoperative 12 months in the ticagrelor group was 0.00%,which was significantly lower than that of the double dose of clopidogrel(24.00%),and the difference was statistically significant(P<0.05).Conclusion CYP2C19 gene polymorphism is associated with clopidogrel resistance after PCI surgery in coronary heart disease;ticagrelor has better effect in treating clopidogrel resistance.

关 键 词：CYP2C19基因多态性 冠心病 氯吡格雷抵抗 替格瑞洛 

分 类 号：R541.4[医药卫生—心血管疾病] Q78[医药卫生—内科学]