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冠心病患者CYP2C19基因型分布特点及其基因型指导PCI术后抗血小板治疗的效果

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
2016年第6期
页码:
676-679,693
栏目:
临床研究
出版日期:
2016-07-05

文章信息/Info

Title:
CYP2C19 genotype and its role in anti-platelet therapy in patients after percutaneous coronary intervention
作者:
王 锦1; 2; 李伟杰1; 李 敏2; 司 瑞1; 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;  LI Min2;  SI Rui1;  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:
细胞色素2C19; 基因多态性; 经皮冠脉介入术; 氯吡格雷; 主要心血管不良事件; 随访研究
Keywords:
CYP2C19;  polymorphism;  percutaneous coronary intervention;  clopidogrel;  major adverse cardiovascular events;  follow-up study
分类号:
R541.4
DOI:
-
文献标识码:
A
摘要:
目的 探讨中国西北地区汉族部分冠心病患者CYP2C19基因型分布特点，依据基因检测指导PCI术后氯吡格雷抗血小板治疗。方法 ①入选2013年1月~7月在西京医院心内科诊断冠心病患者且行基因型检测共2 117例，根据不同等位基因功能缺失分为快代谢基因型（*1/*1）；中间代谢型 CYP2C19（*1/*2）、（*1/*3）；慢代谢型CYP2C19（*2/*2）、（*2/*3）、（*3/*3）；②选择上述临床资料完整的急性冠脉综合征（ACS）患者共864例，于术后1，3，6，9和12个月随访两组间主要不良心血管事件(MACE)发生情况。结果 ①检测入选的2 117例患者基因型结果显示，快代谢型885例，发生率41.80%，中间代谢型971例，发生率45.86%，慢代谢型261例，发生率12.32%；对入组患者一般临床资料统计分析，各组基因型在性别、不同地区、不同年龄分布的比较均存在差异，具有统计学意义。②快代谢型（正常代谢组）患者346例，中间代谢和慢代谢型（弱代谢组）患者461例，记录随访结果两组间MACE发生率比为〔7.8%（27/346） vs. 5.4%（25/461）〕，两组间无统计学差异。结论 ①入选患者基因型突变以*1/*2为主，各组在性别、地区、年龄组分布的比较均存在差异；②按患者CYP2C19基因型调整氯吡格雷用量进行抗血小板治疗是有效的。
Abstract:
AIM To investigate the correlation between the distribution of description CYP2C19 polymorphism and its role in anti-platelet therapy in patients with acute coronary syndrome after percutaneous coronary intervention (PCI). METHODSA total of 2117 patients diagnosed as having coronary atherosclerotic heart diseases in Xijing Hospital were selected and gene polymophisms were analyzed. Based on the loss of function allele gene, the cases were divided into three genotypes: fast metabolic genotype (*1/*1), intermediate metabolic genotype (*1/*2, *1/*3) and slow metabolic genotype (*2/ *2, *2/*3, *3/*3). Eight hundred and sixty-four cases with complete clinical data from the 2117 cases were divided into normal metabolic group (fast metabolic genotype, n=346) and poor metabolic group (intermediate metabolic genotype and slow metabolic genotype, n=461) and received anti-platelet therapy. Major adverse cardiovascular events (MACE) were recorded and compared 1, 3, 6, 9 and 12 months post-PCI between two groups. RESULTSAccording to gene type, 885 cases (41.80%) were fast metabolic genotype, 971 cases (45.86%) were intermediary metabolism genotype and 261 cases (12.32%) were slow metabolic genotype. Loss of follow-up was 36 cases and 21 cases, respectively, in normal metabolic 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 metabolic group and poor metabolic group. CONCLUSIONThe 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 metabolic group and poor metabolic group. Post-PCI anti-platelet therapy based on genotype may increase effectiveness.

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备注/Memo

备注/Memo:
收稿日期：2015-10-15.
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: 2016-07-10