冠状动脉介入术后外周血微小核糖核酸-145表达与急性冠状动脉综合征患者氯吡格雷抵抗的相关性研究  

Study on the relationship between the expression of miR-145 in peripheral blood after coronary intervention and clopidogrel resistance in patients with acute coronary syndrome

作　　者：张传西 张宇[1] 郭莎莎 厉菁[1] 袁义强[1] 王明杰 ZHANG Chuanxi;ZHANG Yu;GUO Shasha;LI Jing;YUAN Yiqiang;WANG Mingjie(Department qf Internal Medicine-Cardiovascular,The 7^(th)Hospital of Zhengzhou,Zhengzhou 450000,China)

机构地区：[1]郑州市第七人民医院(郑州市心血管病医院)心内科,450000

出　　处：《心肺血管病杂志》2021年第10期1015-1019,共5页Journal of Cardiovascular and Pulmonary Diseases

基　　金：河南省医学科技公关项目(2017T02096)。

摘　　要：目的:探究血小板微小核糖核酸-145(miR-145)、细胞色素P450 2C19(CYP2C19)基因型与急性冠状动脉综合征(ACS)患者经皮冠状动脉介入术(PCI)术后氯吡格雷抵抗(CR)及预后的相关性。方法:选取2018年1月至2019年12月,在本院行PCI术的ACS患者102例进行研究,患者术后均进行常规双联抗血小板治疗,根据患者是否存在CR分为CR组25例和氯吡格雷非抵抗(NCR)组77例。比较两组患者一般资料;分析比较两组患者miR-145表达水平,CYP2C19*2位点、*3位点基因多态性;记录1年内ACS患者PCI术后发生主要不良心血管事件(MACE)的情况;以Logistic回归分析ACS患者PCI术后发生不良预后的危险因素。结果:CR组ACS患者血小板miR-145相对表达量明显高于NCR组(P<0.05);CR组ACS患者CYP2C19*2位点中*1/*1基因型占比明显低于NCR组(P<0.05),*1/*2基因型占比明显高于CR组(P<0.05);CR组ACS患者CYP2C19*3位点中*1/*1基因型占比低于NCR组(P<0.05),*1/*3基因型、*3/*3基因型占比明显高于NCR组(P<0.05);CR组ACS患者PCI术后MACE总发生率明显高于NCR组(P<0.05);miR-145是ACS患者PCI术后的保护因素(P<0.05),CYP2C19*2位点是ACS患者PCI术后的危险因素(P<0.05)。结论:血小板miR-145表达水平、CYP2C19基因多态性有助于评估ACS患者PCI术后CR及预后情况,临床需要密切关注。Objective: To investigate the correlation between Platelet microRNA-145(miR-145), cytochrome P450 2 C19(CYP2 C19) genotype and clopidogrel resistance(CR) and prognosis in patients with acute coronary syndrome(ACS) after percutaneous coronary intervention(PCI). Methods: A total of 102 ACS patients who underwent PCI in our hospital from January 2018 to December 2019 were selected for study, and all patients were treated with routine dual antiplatelet therapy. According to the presence of CR, the patients were divided into CR group(25 cases) and non clopidogrel resistant(NCR) group(77 cases). The general data of the two groups were compared;the expression level of miR-145, the gene polymorphism of CYP2 C19*2 and * 3 were analyzed and compared between the two groups;the major adverse cardiovascular events(MACE) were recorded in ACS patients after PCI within one year;and Logistic regression was used to analyze the risk factors of adverse prognosis in ACS patients after PCI. Results: The relative expression of miR-145 in patients with ACS in CR group was significantly higher than that in NCR group(P< 0.05);the proportion of *1/*1 genotype in CYP2 C19*2 locus of ACS patients in CR group was significantly lower than that in NCR group(P < 0.05), and the proportion of *1/*2 genotype was significantly higher than that in CR group(P < 0.05);the proportion of *1/*1 genotype in CYP2 C19*3 locus of ACS patients in CR group was lower than that in NCR group(P < 0.05), and the proportions of *1/*3 genotype and *3/*3 genotype were significantly higher than those in NCR group(P < 0.05);the total incidence of MACE in patients with ACS in CR group was significantly higher than that in NCR group(P< 0.05);miR-145 was the protective factor of poor prognosis in ACS patients after PCI(P < 0.05), and CYP2 C19*2 locus was the risk factor of poor prognosis in ACS patients after PCI(P < 0.05). Conclusions: Platelet miR-145 expression level and CYP2 C19 gene polymorphism are helpful to evaluate CR and prognosis of ACS patients after PCI, which

关 键 词：微小核糖核酸-145 细胞色素P4502C19 急性冠状动脉综合征 经皮冠状动脉介入术 氯吡格雷抵抗 

分 类 号：R54[医药卫生—心血管疾病]