血栓弹力图评价闽东地区汉族人口PCI术后氯吡格雷反应性与CYP2C19基因型相关性研究  

Study on the correlation between postoperative clopidogrel responsiveness and CYP2C19 genotype in Han nationality population at eastern Fujian region by the evaluation of thromboelastogram

作　　者：陈家鑫 林杰[2] 林小惠 林敏华[1] 陈子春[1] CHEN Jia-xin;LIN Jie;LIN Xiao-hui(Department of Clinical Pharmaceutics,Ningde Municipal Hospital,Ningde 352100,China;不详)

机构地区：[1]宁德市医院临床药学室,福建宁德352100 [2]宁德市医院心血管内科,福建宁德352100 [3]福建医科大学研究生学院,福建福州350004

出　　处：《中国医学装备》2020年第6期95-99,共5页China Medical Equipment

基　　金：宁德市科技计划(20150148)“基于CYP2C19基因多态性的血栓弹力图评价经皮冠状动脉支架植入术后患者氯吡格雷治疗效果及其相关性研究”。

摘　　要：目的:氯吡格雷为经皮冠状动脉介入治疗(PCI)术后患者常用的抗血小板药物,为明确闽东地区汉族人口CYP2C19基因的多态性,结合血栓弹力图(TEG)探索CYP2C19基因检测人群,提出根据基因型调整PCI术后氯吡格雷抗血小板的治疗方案。方法:采用前瞻性队列研究,对2987例闽东地区汉族冠状动脉综合征(ACS)患者,采用基因芯片杂交系统进行CYP2C19检测。选取其中的201例ACS患者进行TEG检测,记录最大振幅(MA)、二磷酸腺苷诱导最大血小板聚集率(MAADP)、二磷酸腺苷(ADP)抑制率,并采用统计学方法分析各类人群的MA值及各基因型与氯吡格雷抗血小板效果的相关性。结果:闽东地区汉族人口的CYP2C19基因分布为快代谢型1120例(占37.50%),中等代谢型1444例(占48.34%),慢代谢型423例(占14.16%),男性与女性之间无明显差异。女性及高血压合并PCI术的患者MA显著升高,差异有统计学意义(t=-3.356,t=-2.408;P<0.05),中、慢代谢型患者ADP抑制率显著下降(t=-3.74,t=-4.14;P<0.05),而MAADP显著升高,差异有统计学意义(x^2=32.789,P<0.05)。结论:闽东地区汉族人口携带CYP2C19功能缺失等位基因的比例较高,女性及高血压合并PCI术的患者行CYP2C19基因检测,携带CYP2C19功能缺失等位基因患者需调整氯吡格雷抗血小板治疗方案。Objective:To clear and definite the CYP2C19 gene polymorphism of Han nationality population at eastern Fujian region,and explore the population of CYP2C19 gene detection that combined with thromboelastogram(TEG),and propose therapeutic schedule of antiplatelet of clopidogrel post percutaneous coronary intervention(PCI)that was adjusted according to genotype.Methods:Prospective cohort study was adopted and 2987 patients with acute coronary syndrome(ACS)of Han nationality at eastern Fujian region underwent CYP2C19 detection by hybridization system of gene chip.And 201 patients with ACS in 2987 cases were selected to received TEG detection,and the maximum amplitude(MA),the maximum amplitude of adenosine diphosphate-induced platelet-fibrin clots(MAADP)and inhibition ratio of adenosine diphosphate(ADP)were recorded.Statistical method was adopted to analyze the correlations between the MA value of all kinds of crowd and the effects of Clopidogrel in antiplatelet,and between each genotypes and the effects of Clopidogrel as an antiplatelet medication.Results:The distribution of CYP2C19 gene in Han nationality at eastern Fujian region included extensive metabolizer(EM)(1120 cases,37.50%),intermediate metabolizer(IM)(1444 cases,48.34%),poor metabolizer(PM)(423 cases,14.16%),and the difference of CYP2C19 gene between male and female was no significant.A sharp increase in the MA levels were observed in females and the patients who were hypertension with PCI,and the difference was statistically significant(t=-3.356,t=-2.408,P<0.05).The ADP inhibition rates of patients who were IM and PM were significant reduced(t=-3.74,t=-4.14,P<0.05),while the MAADP level were substantially increased(x^2=32.789,P<0.05).Conclusion:The proportion of the Han nationality population at eastern Fujian region who carry CYP2C19 nonfunctional alleles was larger.The therapeutic schedule of Clopidogrel in antiplatelet for female patients and patients with hypertension and PCI who carry CYP2C19 nonfunctional alleles need be adjusted.

关 键 词：氯吡格雷 CYP2C19基因 血栓弹力图(TEG) 经皮冠状动脉介入治疗(PCI) 

分 类 号：R541.4[医药卫生—心血管疾病]