CYP2C19和ABCB1基因检测指导患者氯吡格雷个体化给药  

Individualized Administration of Clopidogrel in Patients Guided by CYP2C19 and ABCB1 Gene Testing

作　　者：郭秀彩[1] 银雪艳 许启荣[1] 李云波[2] 张紫萍[1] GUO Xiucai;YIN Xueyan;XU Qirong;LI Yunbo;ZHANG Ziping(Twelfth People's Hospital of Guangzhou,Guangzhou,Guangdong 510620}China;The First People's Hospital of Foshan Tongji Rehabilitation Hospital,Foshan,Guangdong 528000,China)

机构地区：[1]广州市第十二人民医院,广东广州510620 [2]佛山市第一人民医院同济康复医院,广东佛山528000

出　　处：《今日药学》2020年第1期36-39,共4页Pharmacy Today

基　　金：广东省医院药学研究基金(2018JZ02)。

摘　　要：目的利用CYP2C19和ABCB1基因检测结果指导患者氯吡格雷个体化用药。方法选取某院2018年8月~2019年6月30例使用氯吡格雷的患者,采用荧光原位杂交法检测患者氯吡格雷相关基因(CYP2C19*17、CYP2C19*3、CYP2C19*2和ABCB1)的基因型,根据检测结果为患者提供给药建议。另选取1例冠状动脉粥样硬化心脏病PCI术后患者,测定氯吡格雷相关基因型,为患者提供个体化给药建议。结果CYP2C19基因检测结果显示,30例患者中1例为超快代谢型,8例为快代谢型,18例为中间代谢型,3例为慢代谢型;ABCB1 CC野生型13例,CT突变杂合型14例,TT突变纯合型3例。1例冠状动脉粥样硬化心脏病患者PCI术后规律双联抗血小板治疗仍反复胸闷胸痛,CYP2C19基因检测为CYP2C19*1/*2中间代谢型,无ABCB1突变,药物代谢减慢,建议氯吡格雷更换为替格瑞洛。结论通过基因检测指导患者氯吡格雷个体化给药,促进临床合理用药。OBJECTIVE To utilize CYP2 C19 and ABCB1 gene testing so as to guide individualized administration of clopidogrel in patients.METHODS Totally 30 patients who received clopidogrel from August 2018 to June 2019 in oua hospital were selected,and the genotypes of clopidogrel-related genes(CYP2 C19*17,CYP2 C19*3,CYP2 C19*2 and ABCB1)were detected by Fluorescence in situ hybridization,and the recommendations were provided for the patients according to genotype.A patient with coronary heart disease after PCI was collected,the genotypes of clopidogrel-related genes were determined.The suggestions about individualized anti-platelet therapy were provided for patients.RESULTS Among 30 patients,the testing result of CYP2 C19 showed that 1 person was ultrarapid metabolizer,8 persons were extensive metabolizers,18 persons were intermediate metabolizers,and 3 persons were poor metabolizers.The testing result of ABCB1 showed that 13 persons had wild type of CC,14 persons had mutant heterozygous type of CT,and 3 persons had mutation homozygous type of TT.A patient with coronary heart disease after PCI was still feeling chest tightness and chest pain,which received standard dual antiplatelet therapy,CYP2 C19 was CYP2 C19*1/*2 intermediate metabolizer,without ABCB1 mutation.It was recommended that clopidogrel should be replaced with ticagrelor by the slowing down of drug metabolism.CONCLUSION Gene detection guide individualized administration of clopidogrel in patients so as to promote clinical rational drug use.

关 键 词：CYP2C19 ABCB1 氯吡格雷 个体化给药 

分 类 号：R743.3[医药卫生—神经病学与精神病学]