基因分型指导下的急性冠脉综合征行PCI患者抗血小板治疗的研究

Study for antiplatelet therapy under guidance of CYP2C19 genotyping in patients with acute coronary syndrome and undergoing PCI

目的:探讨细胞色素P450C19基因(CYP2C19*2)分型指导下急性冠脉综合征(ACS)行PCI患者抗血小板治疗的临床疗效。方法:入选180例行PCI的ACS患者,根据CYP2C19*2等位基因突变情况分为无缺失功能等位基因的野生型组(GG,92例):进行常规双联抗血小板治疗;有缺失功能等位基因的突变杂合型组(AG,67例):在常规双联抗血小板治疗基础上加用西洛他唑50mg,2次/d;突变纯合型组(AA,21例):在常规双联抗血小板治疗基础上加用西洛他唑100mg,2次/d;监测血小板聚集率的变化并比较三组不良心血管事件(MACE)及出血事件的发生情况。结果:ACS患者中的野生型占51.11%,突变杂合型占37.22%、突变纯合型占11.67%。据基因型所分三组临床资料及PCI结果无显著差异。AA组、AG组用药后7d,用药后180d的血小板聚集率均较GG组明显降低[180d:(24.3±3.41)%、(25.8±2.89)%比(30.3±3.17)%,P<0.05]。随访12月,三组的MACE及出血事件发生率无明显差异。结论:三联抗血小板治疗用于CYP2C19*2有缺失功能等位基因(AG或AA)的ACS患者,和双联抗血小板治疗用于CYP2C19*2无缺失功能等位基因的ACS患者比较,血小板聚集率显著降低,但临床效果和安全性相同。CYP2C19*2基因分型可以为个体化抗血小板治疗提供参考。

Objective： To explore antiplatelet therapy curative effects in patients with acute coronary syndrome （ACS） and undergoing percutaneous coronary intervention （PCI） under guidance of cytochrome P450 C19 genoty- ping （CYP2C19 ＊ 2）. Methods： According to CYP2C19＊ 2 mutant alleles, a total of 180 ACS patients undergoing PCI were divided into wild-type group carrying CYP2C19 ＊ 2 no- missing function alleles EGG group, n = 92, re- ceived routine dual antiplatelet （RDA） therapy], mutant heterozygous group carrying CYP2C19 ＊ 2 missing function alleles （AG group, n = 67, received cilostazol 50 rag, twice a day based on RDA therapy）, and mutant homozy- gotes group carrying CYP2C19 ＊ 2 missing function alleles （AA group, n = 21, received cilostazol 100 mg, twice a day based on RDA therapy）. Change of platelet aggregation rate was monitored and incidence of major adverse car- diovascular events （MACE） and bleeding event were compared among three groups. Results： Among 180 ACS pa- tients, the wild-type （GG） group AG group and AA group occupied 51.11%, 37.22% and 11.67% respectively. There were no significant differences in clinical data and PCI results among three groups. On 7th and 180th d after ad- ministration, platelet aggregation rates of AA group and AG group were significantly lower than that of GG group E180d.. （24. 3 ± 3.41） %, （25.8 ± 2.89） % vs. （30.3 ± 3.17） %, P〈0.05]. After 12-month follow-up, there were no significant differences in incidence rates of MACE and bleeding event among three groups. Conclusion： Corn-pared with dual antiplatelet therapy for CYP2C19 ＊ 2 no-missing function alleles （GG type）, the platelet aggregation rates significantly decrease, clinical efficacy and safety were no significant difference in triple antiplatelet therapy for CYP2C19 ＊ 2 missing function alleles （AG or AA type） in ACS patients.