老年急性冠状动脉综合征患者CYP3A5基因多态性与临床疗效及预后的关系  

Relationship of CYP3A5 gene polymorphism with clinical efficacy and outcome in elderly acute coronary syndrome patients

作　　者：兰谋 尹娟 Lan Mou;Yin Juan(No.2 Department of Cardiology,Chongqing Hospital of Traditional Chinese Medicine,Chongqing 400700,China)

机构地区：[1]重庆市北碚区中医院心血管二科,400700

出　　处：《中华老年心脑血管病杂志》2021年第9期933-937,共5页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

摘　　要：目的探讨CYP3A5基因多态性与老年急性冠状动脉综合征(ACS)患者PCI术后替格瑞洛疗效及预后的关系。方法选择我院收治的492例老年ACS患者为研究对象,按随机对照表法分为常规治疗组和个体治疗组各246例。其中常规治疗组给予阿司匹林0.1 g/d联合氯吡格雷75 mg/d治疗;个体治疗组采用单核苷酸多态性基因分型技术进行CYP3A5基因型检测,分为突变基因型142例[AA基因型组(68例)、AG基因型组(74例)]和非突变基因型104例(GG基因型组),AA基因型组和AG基因型组给予拜阿司匹林0.1 g/d联合替格瑞洛90 mg 2次/d治疗,GG基因型组给予常规治疗组相同疗法,持续治疗12个月。采用血栓弹力图仪检测患者的血小板反应性,观察12个月内的ACS患者心源性死亡、再发心肌梗死及心绞痛等终点事件,并采用相对风险度分析CYP3A5基因突变与预后的相关性。结果与常规治疗组比较,个体治疗组总心血管事件发生率明显下降(11.79%vs 21.14%,P=0.005)。2组患者心源性死亡、再发心肌梗死、出血事件等比较无显著差异(P>0.05)。3组不同基因分型患者采取不同的个体化治疗方案,不良心血管事件发生率比较无显著差异(P>0.05);与个体治疗组比较,常规治疗组血小板抑制率明显下降[(48.84±4.71)%vs(60.52±4.27)%,P<0.05〛。随访12个月,CYP3A5基因多态性(AA+AG、GG)个体治疗组治疗后患者预后及不良心血管事件发生风险无显著相关(OR=0.116,95%CI:0.062~0.226,P=0.156;OR=0.158,95%CI:0.084~0.247,P=0.125)。结论CYP3A5基因多态性不影响PCI术后使用替格瑞洛治疗的老年ACS患者的疗效,不增出血风险,且与患者临床预后无明显关联。Objective To study the relationship of CYP3A5 gene polymorphism with clinical effica-cy of ticagrelor and outcome in elderly acute coronary syndrome(ACS)patients after PCI.Meth-ods Four hundred and ninety-two elderly ACS patients admitted to our hospital from February 2017 to February 2019 were randomly divided into conventional treatment group(n=246)and in-dividual treatment group(n=246).The patients in conventional treatment group were given aspi-rin(0.1 g/d)combined with clopidogrel(75 mg/d).The CYP3A5 genotypes in individual treat-ment group were detected using the SNaPshot SNP genotyping technology.The patients in indi-vidual treatment were divided into mutant genotype group(n=142)and non-mutant genotype(GG genotype)group(n=104).The 142 patients in mutant genotype group were further divided into AA genotype group(n=68),AG genotype group(n=74).The AA genotype group and AG genotype group were given Bayaspirin(0.1 g/d)combined with ticagrelor(90 mg,twice a day),and the GG genotype group received the same therapy for conventional treatment group for 12 months.The reactivity of platelets was tested by thromboelastography.The endpoint events,such as cardiogenic death,recurrent myocardial infarction and angina pectoris in ACS patients were recorded within 12 months.The relationship between CYP3A5 gene mutation and outcome in ACS patients was analyzed by relative risk analysis.Results The incidence of total cardiovas-cular events was significantly lower in individual treatment group than in conventional treatment group(11.79%vs 21.14%,P=0.005).No significant difference was detected in cardiogenic death,recurrent myocardial infarction and bleeding events between the two groups(P>0.05).The patients in AA genotype group,AG genotype group and GG genotype group received a differ-ent individualized treatment plan respectively with no significant difference detected in the inci-dence of total cardiovascular events(P>0.05).The platelet inhibition rate was significantly low-er in conventional treatment group than in individu

关 键 词：急性冠状动脉综合征 细胞色素P-450 CYP3A 多态性 单核苷酸 基因型 经皮冠状动脉介入治疗 

分 类 号：R541.4[医药卫生—心血管疾病]