在CYP2C19基因型检测的指导下用药治疗对ACS患者PCI术后的影响  

Influence of Drug Therapy on ACS Patients after PCI under the Guidance of CYP2C19 Genotype Detection

作　　者：苏博万 海晓琴 翟亚芳 李秀芬[1] SU Bowan;HAI Xiaoqin;ZHAI Yafang;LI Xiufen(Department of Cardiology,Hospital of Traditional Chinese Medicine Affiliated to Xinjiang Medical University,Urumqi,Xinjiang Uygur Autonomous Region,830001 China)

机构地区：[1]新疆医科大学附属中医医院心内三科,新疆乌鲁木齐830001

出　　处：《中外医疗》2023年第10期120-124,共5页China & Foreign Medical Treatment

基　　金：新疆医科大学大学生创新训练计划项目(CX2020045)。

摘　　要：目的探讨急性冠脉综合征(acute coronary syndrome,ACS)患者经皮冠状动脉介入(percutaneous coronary intervention,PCI)术后再灌注心律失常与CYP2C19基因多态性的关系。方法随机选取2020年5—7月新疆医科大学附属中医医院于收治的60例行PCI治疗的ACS患者为研究对象,根据患者CYP2C19基因型及血小板个体化治疗方案分为4组,A组快代谢18例,B、C组中代谢各15例,D组慢代谢12例。4组患者均采用双联抗血小板治疗,每组均治疗两周。比较术后4 h各组TIMI血流分级情况,比较治疗前、治疗两周后各组心肌损伤标志物水平,比较再灌注后4 h内各类型再灌注性心律失常(RA)的发生率。结果术后4 h,各组间无灌流人数所占比例比较,差异无统计学意义(Z=2.040,P=0.564)。与治疗前比较,各组治疗两周后的血清cTnI、CK-MB水平均降低,差异有统计学意义(P<0.05);但治疗两周后,各组间cTnI比较,差异无统计学意义(F=2.373,P=0.080)。再灌注后4 h内,各组各类型再灌注性RA的发生率(38.89%、33.33%、40.00%、41.67%)比较,差异均无统计学意义(χ^(2)=0.235,P=0.972)。结论CYP2C19基因型的检测,对临床上指导患者个体化给药、优化治疗以避免药物不良反应和改善再灌注心律失常病情具有重要的临床价值。Objective To investigate the relationship between reperfusion arrhythmia after percutaneous coronary intervention(PCI)and CYP2C19 gene polymorphism in patients with acute coronary syndrome(ACS).Methods Sixty patients with ACS who underwent PCI treated in the Affiliated Hospital of Traditional Chinese Medicine of Xinjiang Medical University from May to July 2020 were randomly selected as the study subjects.They were divided into 4 groups according to CYP2C19 genotype and individualized platelet therapy regimen,following the double-blind principle of clinical trials.There were 18 cases of fast metabolism in group A,15 cases of moderate metabolism in group B and C,and 12 cases of slow metabolism in group D.All 4 groups were treated with dual antiplatelet therapy,and each group was treated for 2 weeks.TIMI blood grading in each group 4 h after surgery,myocardial injury markers before and two weeks after treatment,and the incidence of various types of reperfusion arrhythmia(RA)within 4 h after reperfusion were compared.Results At 4 h after surgery,there was no statistically significant difference in the proportion of people without perfusion among all groups(Z=2.040,P=0.564).Compared with before treatment,serum cTnI and CKMB levels of all groups after 2 weeks of treatment were decreased,and the difference was statistically significant(P<0.05).However,after two weeks of treatment,compared cTnI levels between the groups,and the difference was no statistically significant(F=2.373,P=0.080).Within 4 h after reperfusion,the incidence of different types of RA in each group was compared(38.89%,33.33%,40.00%,41.67%),the difference was not statistically significant(χ^(2)=0.235,P=0.972).Conclusion The detection of CYP2C19 genotype has important clinical value in guiding patients to individual drug administration,optimizing treatment to avoid adverse drug reactions and improving reperfusion arrhythmia.

关 键 词：急性冠脉综合征 再灌注心律失常 经皮冠状动脉介入术 CYP19基因多态性 

分 类 号：R541.4[医药卫生—心血管疾病]