CYP2C19基因多态性与冠心病患者PCI术后氯吡格雷抵抗的关系  

Relationship between CYP2C19 gene polymorphism and clopidogrel resistance after PCI in patients with coronary heart disease

作　　者：李艳华[1] 于学会 胡樑臣 霍鸿波 张龙[1] 孙巍巍[1] 白文征 LI Yan-hua;YU Xue-hui;HU Liang-chen;HUO Hong-bo;ZHANG Long;SUN Wei-wei;BAI Wen-zheng(Department of Emergency,Central Hospital of China National Petroleum and Natural Gas Corporation,Langfang,Hebei,065000,China)

机构地区：[1]中国石油天然气集团公司中心医院急诊科,河北廊坊065000

出　　处：《心血管康复医学杂志》2019年第1期13-16,共4页Chinese Journal of Cardiovascular Rehabilitation Medicine

基　　金：2016年廊坊市科学技术研究与发展计划(2016013186)~~

摘　　要：目的:探讨CYP2C19基因多态性对冠心病患者经皮冠状动脉介入治疗(PCI)术后氯吡格雷抵抗(CR)的影响。方法:选择在我院接受治疗并进行PCI手术的冠心病患者100例,其中CR 24例,无氯吡格雷抵抗(NCR)76例。根据CYP2C19基因型,患者被分为快代谢型CYP2C19*1/*1 (49例),中间代谢型CYP2C19*1/*2(28例)和*1/*3 (11例),慢代谢型CYP2C19*2/*2 (9例)和*2/*3 (3例)。分析不同基因型与CR、最大血小板聚集率(MPA)、主要不良心血管事件(MACE)发生的关系。结果:以快代谢型CYP2C19*1/*1基因型为基础,中间代谢型CYP2C19*1/*2和*1/*3 (OR=4.16、5.03,P均<0.05)及慢代谢型CYP2C19*2/*2和*2/*3 (OR=7.04、17.6,P均<0.01)发生CR的风险显著增加,中间代谢型分别增加4.16和5.03倍,慢代谢型分别增加7.04和17.60倍;与快代谢基因型比较,中、慢代谢基因型的MPA和MACE发生率均显著增加(P<0.05或<0.01);CR组MACE发生率显著高于NCR组(20.8%比5.3%,P=0.02)。结论:CYP2C19基因多态性对冠心病患者PCI术后氯吡格雷抵抗有一定的影响,带有中、慢代谢基因型冠心病患者更易发生氯吡格雷抵抗以及有更高的最大血小板聚集率和主要不良心血管事件发生率。Objective:To explore influence of CYP2C19 gene polymorphism on clopidogrel resistance after percutaneous coronary intervention(PCI)in patients with coronary heart disease(CHD).Methods:A total of 100 CHD patients,who were treated and received PCI in our hospital,were selected.There were 24 cases with clopidogrel resistance(CR,CR group)and 76 cases without CR(NCR,NCR group).According to CYP2C19 genotype,patients were divided into rapid metabolism CYP2C19*1/*1(n=49),medium metabolism CYP2C19*1/*2(n=28)and*1/*3(n=11),and slow metabolism CYP2C19*2/*2(n=9)and*2/*3(n=3).Relationship among different genotypes,CR,maximum platelet aggregation rate(MPA)and incidence of major adverse cardiovascular events(MACE)were analyzed.Results:With rapid metabolism CYP2C19*1/*1 as the base,there was significant rise in CR risk in medium metabolism(CYP2C19*1/*2 and*1/*3,OR=4.16,5.03,P﹤0.05 both)and slow metabolism(CYP2C19*2/*2 and*2/*3,OR=7.04,17.6,P﹤0.01 both),medium metabolism increased by 4.16 and 5.03 times respectively,while slow metabolism increased by 7.04 and 17.60 times respectively.Compared with rapid metabolism genotype,there were significant rise in MPA and incidence rate of MACE in medium and slow metabolism genotypes,P﹤0.05 or﹤0.01;incidence rate of MACE in CR group was significantly higher than that of NCR group(20.8%vs.5.3%,P=0.02).Conclusion:CYP2C19 gene polymorphism possesses certain influence on CR after PCI in CHD patients.Those with medium or slow metabolism genotypes are more likely to suffer from CR,higher MPA and incidence rate of MACE.

关 键 词：冠心病 血管成形术 气囊 冠状动脉 多态性 单核苷酸 

分 类 号：R541.409[医药卫生—心血管疾病]