CYP2C19基因多态性联合血小板功能检测指导抗血小板药物选择对老年ACS患者PCI术后消化道出血的影响分析  

Analysis of the impact of CYP2C19 gene polymorphism combined with platelet function testing on the selection of antiplatelet drugs on gastrointestinal bleeding after PCI in elderly ACS patients

作　　者：陈建福 傅新阳[1] 林荣富 CHEN Jianfu;FU Xinyang;LIN Rongfu(Department of Pharmacy,Quanzhou First Hospital,Quanzhou 362000,Fujian,China)

机构地区：[1]泉州市第一医院药剂科,福建泉州362000

出　　处：《中国临床药理学与治疗学》2024年第9期1019-1026,共8页Chinese Journal of Clinical Pharmacology and Therapeutics

基　　金：泉州市科学技术局科技计划项目(2018Z045);福建省自然科学基金联合资金项目(2023J011763)。

摘　　要：目的:探究CYP2C19基因多态性联合血小板功能检测指导抗血小板药物选择对老年急性冠脉综合征(acute coronary syndrom,ACS)患者经皮冠状动脉介入术(percutaneous coronary intervention,PCI)术后对患者消化道出血的影响。方法:研究选取2021年4月至2022年12月在我院就诊的老年ACS患者并成功完成PCI术216例,并按照随机数表法分为研究组和对照组,每组各108例。术前所有患者均连续4 d服用相同剂量阿司匹林联合氯吡格雷抗血小板治疗;术后对研究组进行CYP2C19基因型检测得到基因型分组,以区分不同的代谢型,将中间代谢型患者进行血栓弹力图(thromboelastogram,TEG)检测根据结果挑选出血小板抑制率低于50%(氯吡格雷抵抗型)的患者,改用阿司匹林和替格瑞洛;对照组则一直采用阿司匹林和氯吡格雷治疗。观察PCI术后5周患者血清的心肌肌钙蛋白(cardiac troponin,cTnI)、肌酸激酶同工酶(creatine kinase isoenzyme,CK-MB)、超敏C-反应蛋白(hypersensitive Creactive protein,hs-CRP)水平,并进行观察患者术后第1、6个月的不良心血管事件(major adverse cardiovascular events,MACE);比较两组患者用药前以及用药7 d和14 d的血小板CD62P、纤维蛋白原受体1(fibrinogen receptor 1,PAC-1)表达情况;并且比较两组的血小板聚集率;治疗后患者消化道出血事件以及记录心脏急症发生情况。结果:患者经过基因检测可知氯吡格雷超快代谢型有21例(19.44%)和快代谢型有25例(23.15%)和异常代谢型包括中间代谢型有42例(基因型分别占比为10.19%、13.89%、9.26%和5.56%)和慢代谢型有20例(基因型分别占比8.33%、7.41%和2.78%)。患者术后5周后,研究组的血清cTnI、hs-CRP及CK-MB水平均低于对照组(P<0.05,P<0.01)。术后1个月,观察组和对照组MACE总发生率变化相近(P>0.05);术后6个月,观察组MACE总发生率较对照组降低(P<0.05);研究组治疗后7 d和14 d的CD62P和PAC-1表达水平较对照组降低(P<0.01)AIM:To investigate the effect of CYP2C19 gene polymorphism combined with platelet function test guiding antiplatelet drug selection on gastrointestinal bleeding in elderly patients with acute coronary syndrome(ACS)after percutaneous coronary intervention(PCI).METHODS:A total of 216 elderly patients with ACS who were admitted to our hospital from April 2021 to December 2022 and successfully completed PCI were selected and divided into study group and control group according to the random number table method,with 108 cases in each group.All patients received 4 days the same dose aspirin combined with clopidogrel antiplatelet therapy before surgery.After surgery,CYP2C19 genotype detection was performed on the study group to obtain genotype grouping to distinguish different metabolites.Thromboelastogram(TEG)detection was performed on the patients with intermediate metabolites.According to the results,patients with platelet inhibition rate less than 50%(clopidogrel resistance type)were selected and their medication was changed from aspirin and clopidogrel to aspirin and ticagrelor.The control group was treated with aspirin and clopidogrel.Serum levels of cardiac troponin(cTnI),creatine kinase isoenzyme(CK-MB)and hypersensitive C-reactive protein(hs-CRP)were observed 5 weeks after PCI,and major adverse cardiovascular events(MACE)were observed 1 and 6 months after PCI.The expression of CD62P and fibrinogen receptor 1(PAC-1)in platelets of the two groups were compared before and after 7 and 14 days of treatment.The platelet aggregation rate of the two groups was compared.Gastrointestinal bleeding events and cardiac emergencies were recorded after treatment.RESULTS:Genetic tests showed that there were 21 cases(19.44%)of ultrafast metabolites and 25 cases(23.15%)of fast metabolites,42 cases of abnormal metabolites including intermediate metabolites(genotypes accounting for 10.19%,13.89%,9.26%and 5.56%,respectively)and 20 cases of slow metabolites(genotypes accounting for 11,respectively.8.33%,7.41%and 2.78%).5 weeks after

关 键 词：CYP2C19基因多态性 血小板功能 老年ACS患者 PCI术 影响分析 

分 类 号：R969[医药卫生—药理学]