PCI术后CYP2C19基因多态性与不同剂量氯吡格雷药物效果的相关性  

Correlation between CYP2C19 gene polymorphism and different doses of clopidogrel after PCI

作　　者：钟欢妹 向波[2] 何玉花 陈丹娜 苏海芳 ZHONG Huan-mei;XIANG Bo;HE Yu-hua(Department of Clinical Laboratory,the Fourth Affiliated Hospital of Guangzhou Medical University,Guangzhou 511300,China;不详)

机构地区：[1]广州医科大学附属第四医院检验科,广州511300 [2]广州医科大学附属第一医院检验科,广州510120 [3]广州医科大学附属第四医院心血管内科,广州511300

出　　处：《中国处方药》2023年第11期12-15,共4页Journal of China Prescription Drug

摘　　要：目的 探讨PCI术后CYP2C19基因多态性与不同剂量氯吡格雷药物效果的相关性。方法 通过基因芯片检测技术,筛选2022年1月~12月收治的PCI术后CYP2C19基因突变为CYP2C19*2/*2、CYP2C19*2/*3的患者142例,按照随机数字法分为常规组(n=47)、2倍组(n=47)、3倍组(n=48),其中常规组术后予氯吡格雷80 mg,2倍组术后予氯吡格雷160 mg,3倍组术后予氯吡格雷240 mg治疗。于PCI术后6个月内通过血栓弹力图检测各组氯吡格雷药物抑制情况,并比较各组术后6个月治疗期间和随访3个月期间患者的出血发生率、心血管缺血事件发生率及凝血功能。结果 三组出血发生率分别为12.77%、10.63%、10.42%,三组患者出血发生率相比,差异无统计学意义(P> 0.05);与常规组相比,2倍组和3倍组患者血管缺血事件显著减少,差异有统计学意义(P <0.05);与常规组相比,2倍组和3倍组的纤维蛋白原(FIB)和D-二聚体水平明显降低,差异有统计学意义(P <0.05);与常规组相比,2倍组和3倍组氯吡格雷药物抑制率明显升高,差异有统计学意义(P <0.05)。结论 CYP2C19基因变异患者服用增加剂量的氯吡格雷可以降低患者血栓风险及心血管缺血事件发生率,在一定程度上可提高血小板的抑制,且不增加出血事件的发生率。Objective To investigate the correlation between CYP2C19 gene polymorphism and different doses of clopidogrel after PCI.Methods A total of 142 patients with CYP2C19*2/*2 and CYP2C19*2/*3 mutations after PCI were selected from January 2022 to December 2022 through gene chip detection technology.They were divided into conventional group(n = 47),2x group(n = 47) and 3x group(n = 48) according to random number method,in which the conventional group was treatde with clopidogrel 80 mg,the 2x group was treated with clopidogrel 160 mg and the 3x group was treated with clopidogrel 240 mg.The inhibition of clopidogrel in each group was detected by thromboelasticity chart with in 6 months after PCI,and the incidence of hemorrhage,incidence of cardiovascular ischemic events and coagulation function of patients in each group during 6 months of treatment and 3 months of follow-up were compared.Results The incidence of hemorrhage in the three groups was 12.77%,10.63% and 10.42%,respectively,there was no significant difference in the incidence of hemorrhage among the three groups(P>0.05).Compared with conventional group,the ischemic events were significantly decreased in the 2x and 3x groups,the differences were statistically significant(P<0.05).Compared with conventional group,FIB and D-dimer levels in 2x and 3x groups were significantly decreased,the differences were statistically significant(P<0.05).The rate of drug inhibition of clopidogrel in 2x group and 3x group was significantly higher than that in conventional group,the difference was statistically significant(P<0.05).Conclusion In patients with CYP2C19 gene mutation,increased dosage of clopidogrel can reduce the risk of thrombosis and the incidence of cardiovascular ischemia time in patients,improve platelet inhibition to a certain extent,and do not increase the incidence of bleeding events.

关 键 词：氯吡格雷 基因多态性 CYP2C19 抗血小板 

分 类 号：R969[医药卫生—药理学]