氯吡格雷抵抗与基因多态性的关系及其治疗对策的研究进展  

Research progress on the relationship between Clopidogrel resistance and gene polymorphism and its treatment strategies

作　　者：农媛[1] NONG Yuan(Department of Neurology,the People's Hospital of Guigang,Guangxi Zhuang Autonomous Region,Guigang537100,China)

机构地区：[1]广西壮族自治区贵港市人民医院神经内科,广西贵港537100

出　　处：《中国当代医药》2023年第2期31-36,41,共7页China Modern Medicine

基　　金：广西壮族自治区贵港市科学研究与技术开发计划项目(贵科计2117018)。

摘　　要：氯吡格雷作为最常用的一线抗血小板药,被广泛应用于心脑血管性疾病的二级预防治疗中。但在临床中,有部分患者存在氯吡格雷反应不佳,抗血小板作用不足现象,即氯吡格雷抵抗,导致缺血事件再发。目前多个研究显示,造成氯吡格雷抵抗的主要因素为参与氯吡格雷代谢的酶的基因多态性所致,而其中以CYP2C19基因为主。不同的等位基因可影响氯吡格雷活性代谢物的生成,从而影响其对血小板聚集的抑制作用。而基于CYP2C19基因检测进行氯吡格雷处方,指导个体化抗血小板治疗可有效减少患者主要不良心血管事件的发生,但如何进行个体化干预,目前尚无统一方案。本文就氯吡格雷抵抗与基因多态性的关系,及氯吡格雷抵抗治疗策略的研究进展做一综述,旨在帮助临床医生理解基因检测结果,及如何根据结果进一步优化药物治疗方案。Clopidogrel is an antiplatelet drug widely used in the secondary prevention of cardiovascular and cerebrovascular diseases.However,in clinical practice,some patients have poor Clopidogrel response and insufficient antiplatelet effect,which was defined as Clopidogrel resistance(CR),that would leads to the recurrence of ischemic events.At present,many studies have shown that the main factor causing CR is the genetic polymorphism of enzymes involved in Clopidogrel metabolism,specially CYP2C19 gene.Different alleles can affect the production of active metabolites of Clopidogrel,thereby affecting the inhibition rate of platelet aggregation.The prescription of Clopidogrel based on CYP2C19 gene detection can effectively reduce the occurrence of major adverse cardiovascular events(MACE)in patients.But,there is no unified strategy on how to carry out individualized treatment at present.This article reviews the relationship between CR and gene polymorphism,and the research progress of CR treatment strategies,in order to help clinicians understand the results of genetic testing and how to further optimize drug treatment according to the results.

关 键 词：氯吡格雷 氯吡格雷抵抗 基因多态性 抗血小板治疗 

分 类 号：R973[医药卫生—药品]