基因检测指导下口服P2Y_(12)抑制剂对冠心病患者PCI后缺血预后的影响  

Effect of Oral P2Y12 Inhibitor on Ischemic Prognosis after PCI in Patients with Coronary Heart Disease under the Guidance of Genetic Testing

作　　者：连延华 张晓乐[1] 高丽[1] Lian Yanhua;Zhang Xiaole;Gao Li(Department of Cardiology,Nanyang Second People's Hospital,Nanyang,Henan 473000,China;不详)

机构地区：[1]南阳市第二人民医院心血管内科,南阳473000

出　　处：《中国循证心血管医学杂志》2022年第3期287-291,共5页Chinese Journal of Evidence-Based Cardiovascular Medicine

基　　金：河南省医学科技攻关计划联合共建项目(2018020966)。

摘　　要：目的探讨基因检测指导下口服P2Y12抑制剂对冠状动脉粥样硬化性心脏病(冠心病)患者经皮冠状动脉介入术(PCI)后缺血预后的影响。方法纳入2018年3月至2019年5月于南阳市第二人民医院就诊的18岁以上急性冠脉综合征(ACS)患者240例,随机分为基因指导治疗组(n=120例)和常规治疗组(n=120例)。基因指导治疗组出现CYP2C19*2或*3功能缺失(LOF)等位基因者使用替格瑞洛和阿司匹林治疗,没有CYP2C19*2或*3LOF患者和常规治疗组使用氯吡格雷和阿司匹林治疗。比较两组随访12个月内治疗结局(主要不良心血管事件和出血事件)的发生情况。结果235例(97.92%)患者在研究期间完成随访或死亡,常规治疗组117例,基因指导治疗组118例,中位随访时间为365 d。常规治疗组发生不良结局事件发生率高于基因指导治疗组[17.5%(21/120)vs.4.2%(5/120),P<0.05]。在所有患者中,经Kaplan-Meier曲线和多因素COX回归分析,使用基因指导治疗组不良结局事件发生率低于常规治疗组(Log Rankχ^(2)=10.164,P=0.001),基因指导治疗比常规治疗方案更有利(HR=4.311,95%CI:1.617~11.490,P<0.05)。仅纳入基因指导治疗组中CYP2C19*2或*3 LOF的患者,基因指导治疗患者不良结局事件发生率低于常规治疗组(Log Rankχ^(2)=5.757,P=0.016),且使用基因指导治疗比常规治疗更有利(HR=3.119,95%CI:1.170~8.315,P<0.05)。结论与常规治疗相比,基因检测指导下口服P2Y12抑制剂可以降低冠心病患者PCI术后的部分出血事件。Objective To investigate the effect of oral P2Y12 inhibitors on the ischemic prognosis of patients with coronary heart disease after percutaneous coronary intervention(PCI)under genetic testing guidance.Method Two hundred forty patients(age>18 yrs)with the acute coronary syndrome(ACS)who were admitted to our hospital from March 2018 to May 2019,and were randomized into gene-guided treatment group(n=120)and conventional treatment group(n=120).In the gene-guided treatment group,patients with CYP2C19*2 or*3 loss-of-function(LOF)alleles were treated with ticagrelor and aspirin.Patients without CYP2C19*2 or*3LOF and the conventional treatment group were treated with clopidogrel and aspirin.The treatment outcomes(major cardiovascular adverse events and minor bleeding events)within 12 months of follow-up were compared between the two groups.Results Two hundred thirty-five patients(97.92%)completed follow-up or died during the study.There were 117 patients in the conventional treatment group and 118 patients in the gene-guided treatment group.The median follow-up time was 365 days.The incidence of adverse outcome events in the traditional treatment group was higher than that in the gene-directed treatment group[17.5%(21/120)vs.4.2%(5/120),P<0.05].In all patients,multivariate COX regression model and Kaplan-Meier curve results showed that the incidence of adverse outcome events in the gene-guided treatment group was lower than that in the conventional treatment group(Log Rankχ^(2)=10.164,P=0.001).The gene-guided treatment was better than traditional treatment(HR=4.311,95%CI:1.617~11.490,P<0.05).For CYP2C19*2 or*3 LOF patients in the gene-guided treatment group,the incidence of adverse outcomes is lower than that in the conventional treatment group(Log Rankχ^(2)=5.757,P=0.016).The use of gene-guided therapy was also more advantageous than traditional therapy(HR=3.119,95%CI:1.170~8.315,P<0.05).Conclusion Compared with routine treatment,oral P2Y12 inhibitor under the guidance of gene testing can reduce some bleeding events

关 键 词：急性冠脉综合征 经皮冠状动脉介入治疗 主要不良心血管事件 CYP2C19基因多态性 

分 类 号：R541.4[医药卫生—心血管疾病]