CYP2C19、ABCB1和PON1基因多态性对ACS病人PCI术后氯吡格雷治疗的影响  

Effect of the CYP2C19,ABCB1 and PON1 gene polymorphisms on the clopidogrel in the treatment of ACS after PCI

作　　者：后世翔 方存明 栾家杰[3] 王敏[1] HOU Shi-xiang;FANG Cun-ming;LUAN Jia-jie;WANG Min(Department of Pharmacy,Xuancheng People′s Hospital of Anhui,Xuancheng Anhui 242000;Department of Cardiology,Xuancheng People′s Hospital of Anhui,Xuancheng Anhui 242000;Department of Pharmacy,Yijishan Hospital Affiliated to Wannan Medical College,Wuhu Anhui 242001,China)

机构地区：[1]安徽省宣城市人民医院药学部,242000 [2]安徽省宣城市人民医院心内科,242000 [3]皖南医学院附属弋矶山医院药剂科,安徽芜湖242001

出　　处：《蚌埠医学院学报》2021年第5期606-610,共5页Journal of Bengbu Medical College

基　　金：安徽省2016年度第一批科技项目(1604a0802097);医学科研发展基金项目(TB206003)(北京康盟慈善基金会)。

摘　　要：目的:研究CYP2C19、ABCB1和PON1基因多态性对急性冠状动脉综合征(ACS)病人经皮冠状动脉介入术(PCI)后氯吡格雷治疗的影响。方法:选取PCI术后服用阿司匹林和氯吡格雷双联抗血小板治疗的ACS病人196例,根据病人CYP2C19、ABCB1、PON1基因检测结果,分为正常组172例和慢代谢组24例,分别给予常规治疗和替格瑞洛替代对照治疗。所有病人连续服用药物5 d后测定血小板聚集率,并对病人进行1年临床随访,记录主要心血管不良事件,比较病人血小板聚集率和临床终点事件。结果:PON1、CYP2C19、ABCBl不同分型病人血小板聚集率间差异均有统计学意义(P<0.01)。随访1年,PON1、CYP2C19、ABCBl不同分型病人临床终点事件间差异均无统计学意义(P>0.05)。正常组病人随访心血管不良事件16例,严重出血事件4例,而慢代谢组均无心血管不良事件及严重出血事件发生,但2组间差异均无统计学意义(P>0.05)。结论:CYP2C19、ABCB1和PON1基因多态性与冠心病病人PCI术后氯吡格雷抵抗有一定关系,慢代谢病人应用替格瑞洛可能具有较好临床效果。Objective:To investigate the effects of the gene polymorphisms of CYP2C19,ABCB1 and PON1 on clopidogrel in the treatment of acute coronary syndromes(ACS)after percutaneous coronary intervention.Methods:A total of 98 patients treated with dual antiplatelet therapy of aspirin and clopidogrel after PCI were divided into the normal group(172 cases)and slow metabolism group(24 cases)according to the gene detection of CYP2C19,ABCB1 and PON1.The normal group and slow metabolism group were given the routine treatment and ticagrelor instead of control treatment,respectively.The platelet aggregation rates in two groups were measured after 5 days of continuous treatment,and the patients were followed up for 1 year.The major cardiovascular adverse events were recorded in two groups,and the platelet aggregation rates and clinical endpoint events were compared between two groups.Results:The differences of the platelet aggregation rates among the patients with different types of PON1、CYP2C19、ABCBl were statistically significant(P<0.01).After 1 year of following up,the differences of the clinical endpoint events among the patients with different types of PON1、CYP2C19、ABCBl were not statistically significant(P>0.05).There were 16 cases with adverse cardiovascular events and 4 cases with severe bleeding events in the normal group,while there was not adverse cardiovascular events or severe bleeding events in the slow metabolic group,and the difference of which was not statistically significant(P>0.05).Conclusions:The polymorphisms of CYP2C19,ABCB1 and PON1 genes are associated with clopidogrel resistance in CHD patients after PCI.Ticagrelor may have better clinical effectsin patients with slow metabolism.

关 键 词：急性冠状动脉综合征 经皮冠状动脉介入术 氯吡格雷 CYP2C19 三磷酸腺苷黏合转运体B1 对氧磷酶1 

分 类 号：R541.4[医药卫生—心血管疾病]