CYP2C19基因检测在非体外循环冠状动脉旁路移植术后抗血小板治疗的指导作用  

The role of CYP2C19 gene assay in antiplatelet therapy after off-pump coronary artery bypass grafting

作　　者：胡晖[1] 刘长城[1] 王粮山 宋伟[1] 于洋[1] 顾承雄[1] Hu Hui;Liu Changcheng;Wang Liangshan;Song Wei;Yu Yang;Gu Chengxiong(Department of Cardiovascular Surgery,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院心脏外科,100029

出　　处：《中华胸心血管外科杂志》2019年第1期45-48,共4页Chinese Journal of Thoracic and Cardiovascular Surgery

基　　金：国家自然科学基金(81370436).

摘　　要：目的评价CYP2C19基因检测在非体外循环下冠状动脉旁路移植术后双联抗血小板治疗中的指导作用。方法选取2017年5月至2018年5月244例符合入组条件的择期行OPCABG术患者,男221例,女23例;平均年龄(62.1±9.3)岁。患者按数字表法随机分为2组:氯吡格雷组(术后接受100mg/次阿司匹林+75mg/次氯吡格雷,1次/天)和替格瑞洛组[术后接受100mg/次阿司匹林(1次/天)+90mg/次替格瑞洛(2次/天)],每组122例。两组分别在术前1天和双联抗血小板治疗后1、4、7天检测血小板聚集率,术后30天观察主要不良心血管事件发生率。结果双联抗血小板治疗后1天,替格瑞洛组血小板聚集率显著低于氯吡格雷组[(28.5±9.7)%对(51.8±16.8)%,P<0.05)]。双联抗血小板治疗后4天,替格瑞洛组血小板聚集率趋于稳定。术后30天,氯吡格雷组和替格瑞洛组主要不良心血管事件发生率分别为3.3%和1.6%。亚组分析结果显示,替格瑞洛+阿司匹林可降低接受冠状动脉内膜剥脱术患者的主要不良心血管事件发生率,P=0.043。结论根据CYP2C19基因检测结果,表现为氯吡格雷慢代谢患者术后应用替格瑞洛代替氯吡格雷的双联抗血小板治疗可明显缩短达到满意血小板聚集率的用药时程,并可降低冠状动脉内膜剥脱术患者主要不良心血管事件的发生风险。Objective To evaluate the guiding role of CYP2C19 gene assay in dual antiplatelet therapy(DAPT) after off-pump coronary artery bypass grafting(OPCABG). Methods The patients who received scheduled OPCABG between May 2017 and May 2018 were recruited in this study. According to the results of CYP2C19 gene assay, the patients who carried CYP2C19 gene *2/*2,*2/*3 and *3/*3 mainly causing slow metabolism of clopidogrel were randomly divided into two groups: the clopidogrel group(patients receiving 100mg/qd aspirin plus 75mg/qd clopidogrel after surgery ), the ticagrelor group(patients receiving 100mg/qd aspirin plus 90mg/bid ticagrelor after surgery). Patients in the two groups underwent platelet aggregation rate test first day before surgery and the 1, 4, 7 days antiplatelet therapy after surgery. And the major adverse cardiac events(MACE) was investigated 30 days after surgery in the two groups. Results A total of 244 patients were recruited in the study with the clopidogrel group(n=122) and the ticagrelor group(n=122). The platelet aggregation rate after one day of postoperative DAPT in the ticagrelor group was lower than that in the clopidogrel group[(28.5±9.7)% VS(51.8±16.8)%, P<0.05]. After 4 days of postoperative DAPT, platelet aggregation rate in the ticagrelor group maintained a stable and desired level. The MACE 30 days after surgery in the clopidogrel group and the ticagrelor group were 3.3% and 1.6% respectively, and ticagrelor plus aspirin reduced MACE in patients undergone coronary endarterectomy, P=0.043. Conclusion According to the results of CYP2C19 gene assay, ticagrelor replacing clopidogrel could shorten the duration of desired platelet aggregation rate in patients with DAPT after OPCABG, and may be reduce the risk of MACE after OPCABG and coronary endarterectomy.

关 键 词：CYP2C19基因 氯吡格雷 替格瑞洛 冠状动脉分流术 血小板聚集率 

分 类 号：R654.2[医药卫生—外科学]