基于CYP2C19基因型指导临床氯吡格雷用药现状研究  

Clinical application of clopidogrel based on CYP2C19 genotype

作　　者：张旭[1] 蒲琴[1] 邸云峰 赵良 王勇[1] ZHANG Xu;PU Qin;DI Yun-feng(Sichuan Mianyang 404 Hospital Clinical Laboratory,Sichuan Mianyang 621000)

机构地区：[1]四川绵阳四0四医院检验科,四川绵阳621000 [2]四川绵阳四0四医院心内科,四川绵阳621000

出　　处：《医学检验与临床》2021年第4期20-24,共5页Medical Laboratory Science and Clinics

基　　金：四川省医学科研青年创新课题(No.Q17063)。

摘　　要：目的:研究药物代谢基因CYP2C19检测结果对临床氯吡格雷用量指导情况现状,并对其指导用药效果进行追踪、评价。方法:搜集2019年1月~2020年3月于我院住院检测CYP2C19基因型患者样本,分析CYP2C19基因型的分布情况,并于出院半年后通过电话、门诊或住院查询等方式对患者进行随访,评估基于CYP2C19基因型调整氯吡格雷用药后与主要不良心血管事件(major adverse cardiac events,MACE)发生情况的关系。结果:428例患者中,超快、快、中和慢代谢型分别为1.4%(6/428)、37.6%(161/428)、43.9%(188/428)和17.1%(161/428);CYP2C19基因型在性别、年龄和送检科室的分布差异无统计学意义(P>0.05);有效随访的227例患者中,超快、快、中、慢代谢型用药调整率分别为0%(0/3)、9.2%(8/87)、24.7%(22/89)、41.7%(20/48),差异具有统计学意义(P<0.05);超快/快代谢型组中,未调整用药和调整用药半年后发生MACE分别为19.5%和25.0%,两者差异无统计学意义(P>0.05);中/慢代谢型组中,未调整用药和调整用药半年后发生MACE分别为31.6%和9.5%,两者差异有统计学意义(P<0.05)。结论:通过CYP2C19基因型的检测,可为临床氯吡格雷用药提供指导作用,有效的避免因氯吡格雷抵抗而出现不良心血管事件的发生。Objective:To investigate the status quo of clinical guidance on the dosage of clopidogrel based on the detection results of drug metabolism gene CYP2C19,and to track and evaluate the efficacy of its guidance on medication.Methods:The CYP2C19 genotype samples were collected in our inpatient from January 2019 to March 2020.We analyzed the distribution of CYP2C19 genotype,fbllow-up visited through telephone and inpatient or outpatient after six month discharged from hospital,and evaluated the relationship between adjusted medication based on CYP2C19 genotype and MACE's(major adverse cardiac events,MACE)happen.Results:Among the 428 patients,the ratio of ultra-fast,fast,medium and slow metabolic types were 1.4%(6/428),37.6%(161/428),43.9%(188/428)and 17.1%(161/428),respectively.There was no statistically significant difference in the distribution of CYP2C19 genotype in gender,age,or departments(P>0.05).Among the 227 patients effectively followed up,the adjusted ratio of ultra-fast,fast,moderate and slow metabolic medication were 0%(0/3),9.2%(8/87),24.7%(22/89)and 41.7%(20/48),respectively,and had statistically significant difference(P<0.05).In the ultra-fast/fast metabolic group,the incidence of MACE were 19.5%and 25.0%,respectively,unadjusted and adjusted medication for half a year(P>0.05).In the middle/slow metabolic group,the incidence of MACE were 31.6%and 9.5%,respectively,unadjusted and adjusted medication for half a year(P<0.05).Conclusion:The detection of CYP2C19 genotype provides guidance for the clinical use of clopidogrel,and the MACE caused by clopidogrel resistance would be effectively avoided.

关 键 词：CYP2C19 基因分型 氯吡格雷 用药指导 

分 类 号：R54[医药卫生—心血管疾病]