CYP2C19基因型功能缺失患者介入术后氯吡格雷剂量与心脏不良事件相关性研究

Correlation between clopidogrel dose and cardiac adverse events in patients with loss of CYP2C19 genotype function after PCI

目的探讨CYP2C19基因型功能缺失患者PCI术后,氯吡格雷剂量与心脏主要不良事件的相关性。方法选择择期PCI术后连续服用氯吡格雷患者280例,所有患者均行CYP2C19基因检测,入选CYP2C19基因型功能缺失患者150例,随机分为75mg/d组75例,150mg/d组75例;另设CYP2C19正常代谢型患者(75mg/d)为对照组130例。分别于术后第1天、1、3个月采用血栓弹力图检测血小板抑制率。结果 1个月后75mg/d组和150mg/d组血小板抑制率为(38.3±12.8)%和(51.7±15.6)%(P<0.05);3个月后血小板抑制率为(30.5±18.2)%和(48.3±21.3)%(P<0.05)。75mg/d组有3例出现急性心肌梗死,3例出现支架内血栓形成。150mg/d组无再发心血管缺血事件。结论择期PCI术后,氯吡格雷维持剂量150mg/d较常规75mg/d明显提高血小板抑制率,从而减少支架内血栓、非致死性心肌梗死等心脏主要不良事件发生。

Objective To study the correlation between clopidogrel dose and cardiac adverse events in patients with loss of CYP2C19 genotype function after PCI. Methods CYP2C19 was detected in 280 patients receiving continuous clopidogrel treatment. One hundred and fifty of them with loss of CYP2C19 gene function were randomly divided into 75 mg/d clopidogrel treatment group （n=75） and 150 mg/d clopidogrel treatment group （n=75）. Another 130 patients with normal CYP2C19 metabolism receiving 75 mg/d clopidogrel served as a control group. Their platelet inhi- bition rate was measured 1 day and 1 and 3 months after PCI according to their thrombus elastic graph. Results The platelet inhibition rate was significantly lower in 75 mg/d clopidogrel treat- ment group than in 150 mg/d clopidogrel treatment group 1 and 3 months after PCI （38.3% ± 12.8% vs 51.7%±15.6%,30.5%±18.2% vs 48.3%±21.3%,P〈0.05）. Acute myocardial in- farction and stent thrombosis occurred respectively in 3 patients of 75 mg/d clopidogrel treatment group. No recurrent ischemic cardiovascular event occurred in 150 mg/d clopidogrel treatment group. Conclusion The platelet inhibition rate of ctopidogrel （150 rag/d） is significantly higher than that of clopidogrel （75 mg/d） ,and can thus reduce the major cardiac adverse events, such as stent thrombosis and nonfatal myocardial infarction, in patients with loss of CYP2C19 genotype function after PCI.