细胞色素P450 2C19基因对急性冠状动脉综合征患者介入术后抗血小板治疗的预后影响  

Effect of CYP2C19 genotyping on outcome of antiplatelet therapy in acute coronary syndrome patients after PCI

作　　者：周思远 白静[1] 杨学东[1] 杨霞[1] 王禹[1] Zhou Siyuan;Bai Jing;Yang Xuedong;Yang Xia;Wang Yu(Department of Cardiology,First Medical Center of Chinese PLA General Hospital,Beijing 100853)

机构地区：[1]解放军总医院第一医学中心心内科,北京100853

出　　处：《中华老年心脑血管病杂志》2020年第6期565-567,共3页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基　　金：国家自然科学基金(81670218)。

摘　　要：目的根据细胞色素P450(CYP)2C19基因分型对急性冠状动脉综合征患者(acute coronary syndrome,ACS)PCI术后个体化抗血小板治疗及常规治疗的临床预后影响。方法选择2018年4月~2019年6月解放军总医院第一医学中心心内科就诊的ACS患者282例,随机分为基因分型组141例,患者接受CYP2C19基因分型检测,并根据基因分型个体化抗血小板治疗;常规治疗组141例,患者为氯吡格雷75 mg/d的常规治疗。通过术后6个月随访,比较2组不良心脑血管事件(死亡、急性心肌梗死、支架内血栓、院内治疗的不稳定性心绞痛、缺血性脑卒中或短暂性脑缺血发作)、临床重大出血事件发生率。结果2组术后6个月死亡、急性心肌梗死、院内治疗的不稳定性心绞痛、缺血性脑卒中或短暂性脑缺血发作和临床重大出血事件发生率比较,差异无统计学意义(P>0.05)。常规治疗组支架内血栓发生率明显高于基因分型组,差异有统计学意义(7.1%vs 1.4%,P=0.035)。结论CYP2C19基因分型指导ACS患者PCI术后个体化抗血小板治疗可以降低患者支架内血栓发生率。Objective To study the effect of CYP2 C19 genotyping on the outcome of antiplatelet therapy and conventional therapy in acute coronary syndrome(ACS)patients after PCI.MethodsTwo hundred and eighty-two ACS patients admitted to our center from April 2018 to June 2019 were divided into genotyping group(n=141)and conventional therapy group(n=141).The patients in genotyping group received CYP2 C19 genotyping and antiplatelet therapy while those in conventional therapy group received clopidogrel treatment(75 mg/d).The patients in two groups were followed up for 6 monts,during which the incidence of major adverse cadiocerebrovascular events,including death,AMI,instent thrombosis,unstable angina pectoris(UAP),ischemic cerebral stroke(ICS)and TIA,and major clinical bleeding events were compared.Results No significant difference was detected in the incidence of AMI,UAP,ICS,TIA and major clinical bleeding events between the two groups at month 6 after PCI(P>0.05).The incidence of instent thrombosis was significantly higher in conventional therapy group than in genotyping group(7.1%vs 1.4%,P=0.035).Conculsion CYP2 C19 genotyping-guided antiplatelet therapy can reduce the incidence of instent thrombosis in ACS patients after PCI.

关 键 词：细胞色素P450酶系统 基因型 急性冠状动脉综合征 血小板聚集抑制剂 支架 

分 类 号：R541.4[医药卫生—心血管疾病]