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|本期目录/Table of Contents|

PCI术后患者的CYP2C19基因型分布及其基因型指导抗血小板治疗的效果

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
2015年第2期
页码:
148-151
栏目:
临床研究
出版日期:
2014-10-25

文章信息/Info

Title:
Association between CYP2C19 polymorphisms and effect of antiplatelet therapy in patients after percutaneous coronary intervention
作者:
王 锦1; 2; 李伟杰1; 郭艳杰1; 原平利1; 李 敏2; 郭文怡1
(1.第四军医大学西京医院心内科，陕西 西安 710032；
2.西安一四一医院心内科，陕西 西安 710089)
Author(s):
WANG Jin1; 2;  LI Wei-jie1;  GUO Yan-jie1;  YUAN Ping-li1;  LI Min2;  GUO Wen-yi1
(1.Department of Cardiology, Xijing Hospital, Fourth Military Medical University, Xi’an 710032, Shaanxi, China；
2.Department of Cardiology, Xi’an 141 Hospital, Xi’an 710089, Shaanxi, China)
关键词:
CYP2C19基因型; 经皮冠脉介入术; 氯吡格雷; 心血管不良事件; 随访研究
Keywords:
CYP2C19 genotype;  percutaneous coronary intervention;  clopidogrel;  major adverse cardiac events
分类号:
R541.4
DOI:
-
文献标识码:
A
摘要:
目的:描述中国西北地区汉族人群经皮冠状动脉介入(PCI)术后患者细胞色素P450(CYP2C19)基因多态性分布特点，并评价依据基因型指导PCI术后氯吡格雷抗血小板治疗的效果。方法:①入选2013年1月~7月在西京医院心内科行PCI的来自西北地区汉族患者2 117例行CYP2C19基因型检测，根据不同等位基因功能缺失分为快代谢基因型（*1/*1）、中间代谢基因型（*1/*2、*1/*3）和慢代谢基因型（*2/*2、*2/*3、*3/*3）；②从上述人群中选择临床资料完整的患者153例，按基因型分为2组：正常代谢组（快代谢基因型，59例)和弱代谢组（中间代谢和慢代谢基因型，94例）。正常代谢组患者术后口服氯吡格雷75 mg/d至1年，而弱代谢组氯吡格雷150 mg/d强化治疗1个月，后75 mg/d至1年抗血小板治疗；于术后1、3、6、9和12个月随访并记录和比较两组间主要不良心脑血管事件（MACE）发生情况。结果:①检测入选的2117例患者基因型结果显示，快代谢基因型（*1/*1）885例，发生率41.80%，中间代谢基因型（*1/*2、*1/*3）971例，发生率45.86%，其中*1/*2占39.16%，*1/*3占6.70%，慢代谢基因型（*2/*2、*2/*3、*3/*3）261例，发生率12.32%。②正常代谢组失訪6例，弱代谢组失訪5例，两组失訪率（9% vs. 5%)差异未达到显著水平。正常代谢组和弱代谢组MACE发生率［12.3%(6/59) vs. 10.1%( 8/94)，两组差异也无统计学意义。结论:①入选患者CYP2C19等位基因突变频率发生率高，其中以*1/*2为主，②按基因型采取不同剂量的抗血小板药物后两组MACE发生率差异无统计学意义。
Abstract:
AIM:To investigate the correlation between the distribution of CYP2C19 polymorphisms and the effect of anti-platelet therapy in patients with acute coronary artery disease after percutaneous coronary intervention (PCI). METHODS: We selected 2117 patients diagnosed as having coronary heart disease and treated with PCI in Xijing Hospital. Gene polymorphisms were analyzed in the Han population in northwest China. Based on the loss of functional allele gene, the cases were divided into three gene types: fast metabolic genotypes (*1/*1), intermediate metabolic genotypes (*1/*2, *1/*3) and slow metabolic genotypes (*2/*2, *2/*3 and *3/*3). One hundred and sixty-four cases with complete clinical data from the 2117 cases were divided into normal metabolic group (fast metabolic genotype, n=59) and poor metabolic group (intermediary metabolism and slow metabolic genotype, n=94) and received anti-platelet therapy. The protocol was as follows: normal metabolism group was given oral clopidogrel 75 mg/d for 1 year and the poor metabolic group was given clopidogrel 150 mg/d of intensive treatment in the first month and 75 mg/d from the second month through the 12th month. Major adver se cardiac/cerebrovascular events (MACE) incidences were recorded and compared 1, 3, 6, 9 and 12 months between groups. RESULTS: According to gene type, 885 cases (41.80%) were fast metabolic genotype, 971 cases (45.86%) were intermediate metabolism genotype, and 261 cases (12.32%) were slow metabolic genotype. Loss of follow-up was six cases and five cases, respectively, in normal metabolism group and poor metabolic group. For the effect of anti-platelet therapy, no statistically significant difference was observed in the incidence of MACE between normal metabolism group and poor metabolic group. CONCLUSION: The frequency of CYP2C19 allele mutation is high and mainly genotype *1/*2 in patients after PCI. There is no statistically significant difference in the incidence of MACE between normal metabolism group and poor metabolic group after different doses of anti-platelet therapy.

参考文献/References

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备注/Memo

备注/Memo:
收稿日期：2014-05-12.
通讯作者：郭文怡，教授，主要从事冠心病介入的临床研究 Email:wenyiguo@yahoo.com
作者简介：王锦，主治医师，硕士生 Email:rusherwj@163.com
更新日期/Last Update: 2014-11-18