基于ABCB1 C3435T基因多态性研究氯吡格雷用于急性冠状动脉综合征安全性的荟萃分析  

Safety of clopidogrel in the treatment of the patients with acute coronary syndrome based on ABCB1 C3435T gene polymorphism:a meta analysis

作　　者：李剑钦 杨星辰[1] 史蔚青 LI Jianqin;YANG Xingchen;SHI Weiqing(Department of Pharmacy,Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 200032,China)

机构地区：[1]上海中医药大学附属龙华医院药学部,上海200032

出　　处：《药学服务与研究》2021年第1期6-11,18,共7页Pharmaceutical Care and Research

基　　金：上海中医药大学附属龙华医院自然科学研究基金(Y1817)。

摘　　要：目的:基于ABCB1 C3435T基因多态性,应用荟萃(meta)分析的方法评价急性冠状动脉综合征(acute coronary syndrome,ACS)患者使用氯吡格雷的安全性。方法:检索万方数据库、中国生物医学文献数据库、中国期刊全文数据库、中文科技期刊全文数据库(VIP)以及英文数据库Science Citation Index(SCI)、PubMed、EMBase,检索年限从建库至2019年12月。对收集的文献进行质量评价,使用Stata 14.0软件对提取的数据进行meta分析。结果:最终入选13篇文献,12970例患者。Meta分析显示,基于ABCB1 C3435T基因多态性,各亚组中主要心血管不良事件(major adverse cardiac events,MACE)发生率无显著差异(P>0.05):等位基因模型OR=1.11,95%CI(0.94,1.30),显性基因模型OR=1.03,95%CI(0.82,1.31),隐性基因模型OR=1.13,95%CI(0.99,1.30);而在隐性基因模型中,使用负荷剂量为300 mg氯吡格雷的患者MACE发生率存在显著差异(P<0.05),欧洲人群的MACE发生率也存在显著差异(P<0.05);在所有MACE中,心肌梗死的发生率存在显著差异(P<0.01)。结论:ABCB1 C3435T基因多态性与MACE发生率无相关性,但在使用氯吡格雷负荷剂量300 mg的情况下及在欧洲人群中,MACE发生率与该基因多态性具有相关性。Objective:To evaluate the safety of clopidogrel in the patients with acute coronary syndrome(ACS)by meta analysis based on ABCB1 C3435T gene polymorphism.Methods:The databases,such as Wanfang Data,the Chinese Biomedical Literature Database(CBM),the Chinese Journal Fulltext Database in China National Knowledge Infrastrusture(CNKI),the China Science and Technology Journal Database(VIP),the Science Citation Index(SCI),PubMed and EMBase,were searched from the inception to December 2019.The quality of the collected literature was evaluated,and then meta analysis was performed on the obtained data by using Stata 14.0.Results:Finally,13 papers were included and 12970 patients were enrolled for study.Meta analysis showed that there was no significant difference in the incidence of major adverse cardiac events(MACE)among the subgroups based on ABCB1 C3435T gene polymorphism(P>0.05):in the allele gene model OR=1.11,95%CI(0.94,1.30),in the dominant gene model OR=1.03,95%CI(0.82,1.31)and in the recessive gene model OR=1.13,95%CI(0.99,1.30).In the recessive gene model,there was a significant difference in the incidence of MACE of the patients who received a clopidogrel loading dose of 300 mg(P<0.05)and there was also a significant difference in the incidence of MACE in the European population(P<0.05).And in all MACE,there was a significant difference in the incidence of myocardial infarction(P<0.01).Conclusion:There was no correlation between polymorphism of ABCB1 C3435T gene and MACE incidence,however correlation could be seen in the incidence of MACE and ABCB1 C3435T gene polymorphism,when the patients received a clopidogrel loading dose of 300 mg and in the European population.

关 键 词：氯吡格雷 ABCB1 C3435T基因 基因多态性 主要心血管不良事件 荟萃分析 

分 类 号：R973.2[医药卫生—药品] Q31[医药卫生—药学]