目的 探讨冠心病(coronary artery disease,CAD)介入术后氯吡格雷低反应发生与CYP2C19基因多态性的关系。方法 选取武警总医院心内科行经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI )患者200例,术后给予阿司匹林和氯吡格雷双联抗血小板药,并经血栓弹力图检测二磷酸腺苷(adenosine diphosphate, ADP)诱导的血小板抑制率,按ADP诱导的血小板抑制率是否小于30%,将患者分为氯吡格雷低反应组和氯吡格雷敏感组;同时采用基因芯片技术检测CYP2C19基因多态性,判断对氯吡格雷的反应性的影响。结果 CYP2C19*1/*1与CYP2C19*1/*2、CYP2C19*1/*1与CYP2C19*2/*2、快与中间代谢型比较ADP的抑制率有统计学差异;共79例(39.5%)发生氯吡格雷低反应。氯吡格雷敏感组快代谢型者(基因型*1/*1)多于低反应组(P=0.013),氯吡格雷低反应组中慢代谢型较多(P=0.013),差异均有统计学意义。其他代谢型间比较无差异。结论 冠心病PCI术后氯吡格雷低反应与CYP2C19基因多态性相关,携带中慢代谢型基因者发生氯吡格雷低反应较多。
Abstract
Objective To study the correlation between clopidogrel low respone and CYP2C19 gene polymorphism in coronary artery disease(CAD)patients after percutaneous coronary intervention(PCI). Methods A total of 200 patients with CAD admitted to this hospital from October 2013 to October 2014 were included in this study, and treated with dual antiplatelet drugs, aspirin and clopidogrel after PCI. The clopidogrel response was judged by depending on the ADP-induced platelet inhibition rate tested by thromboelastogram (TEG). In this study the ADP-induced platelet inhibition rate less than 30% was defined as clopidogrel low respone and the gene chip detection technology was used to detect the genotyes of CYP2C19 to further explore its effect on clopidogrel respone. Results In these 200 patients, the ADP-induced platelet inhibition rate was statistically significantly different between patients carrying CYP2C19*1/*1 and CYP2C19*1/*2、CYP2C19*1/*1 and CYP2C19*2/*2、extensive and intermediate metabolizers. The total occurrence of clopidogrel low response was 39.5%(79 patients) . There was significant difference between clopidogrel low respone and CYP2C19 genotyes、 metabolizers, indicating that more carriers with extensive metabolizer (CYP2C19*1/*1) in the clopidogrel response group(P=0.013), more carriers with intermediate or poor metabolizers in the clopidogrel low response group(P=0.013). Conclusions There is correlation between clopidogrel low respone and CYP2C19 gene polymorphism in patients with CAD after PCI, more carriers with intermediate or poor metabolizers in the clopidogrel low response group.
关键词
CYP2C19基因多态性 /
ADP诱导的血小板抑制率 /
冠心病
Key words
CYP2C19 gene polymorphism /
the ADP-induced platelet inhibition rate /
coronary artery disease
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