经皮冠状动脉介入治疗术后患者血小板功能检测及基因检测指导下降阶治疗研究进展  

Research update of platelet function-guided and CYP2C19 genotype-guided de-escalation in patients with acute coronary syndrome after percutaneous coronary intervention

作　　者：赵志刚[1] 孙雪 李雅超 雷梦杰 杨彦立[1] 安蕾 周海立[1] 王敬尧 薛增明[1] ZHAO Zhi-gang;SUN Xue;LI Ya-chao;LEI Meng-jie;YANG Yan-li;AN Lei;ZHOU Hai-li;WANG Jing-yao;XUE Zeng-ming(Department of Cardiology,People’s Hospital of Langfang City,Langfang core laboratory of precision treatment of CAD,Langfang 065000,China)

机构地区：[1]廊坊市人民医院心内科廊坊市冠心病精准治疗重点实验室,河北省廊坊市065000

出　　处：《中国心血管病研究》2022年第12期1147-1152,共6页Chinese Journal of Cardiovascular Research

基　　金：廊坊科技研发计划自筹基金项目(2022013038)。

摘　　要：阿司匹林与P2Y12抑制剂组成的双联抗血小板治疗(dual antiplatelet therapy,DAPT)是经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)术后常用的药物治疗策略。冠状动脉病变类型、手术因素、治疗时期以及多种缺血出血风险评估共同指导了DAPT的调整,但调药后血小板反应性过低或过高也会影响预后,此时监测血小板反应性尤为重要。此外,随着药物相关不良反应的出现,抗血小板药物降阶治疗在临床中的应用逐渐增多,但降阶后患者血小板高反应性也是PCI术后不良事件发生的危险因素,因此降阶治疗是否可在减少药物不良反应的同时控制缺血事件的增加成为临床研究热点。血小板功能检测及CYP2C19基因检测是目前常用的血小板反应性检测方法,其对PCI术后患者抗血小板药物调整的指导价值尚有争议,其指导下的降阶治疗能否改善PCI术后患者的临床预后尚不明确,故作综述。Dual antiplatelet therapy composed of aspirin and P2Y_(12) inhibitor is a common treatment strategy after percutaneous coronary intervention(PCI).The type of coronary artery disease,the operative factors,the period of treatment and the risk assessment of various ischemic and bleeding guide the adjustment of DAPT,but the high or low platelet reactivity after the adjustment of DAPT may also affect the prognosis and it is very important to monitoring platelet reactivity at this time.With the emergence of drug-related adverse reactions,the de-escalation of antiplatelet drugs in clinical treatment is gradually increasing,but high platelet reactivity is also a risk factor for adverse events after PCI.Therefore,whether de-escalation can reduce drug-related adverse reactions and ischemic events meanwhile has become a popular topic of clinical research.Platelet function tests and CYP2C19 genotype tests are commonly used to monitor platelet reactivity at present but its guiding value for the adjustment of antiplatelet drugs in patients after PCI is still controversial.Also,whether the guided de-escalation can improve the clinical prognosis of patients after PCI is not clear.So the progress on the relevant research in recent years were reviewed.

关 键 词：经皮冠状动脉介入治疗 降阶 血小板功能检测 基因检测 预后 

分 类 号：R541.4[医药卫生—心血管疾病]