CYP2C19*17多态性对氯吡格雷临床疗效影响的系统评价

Impact of CYP2C19*17 Gene Polymorphisms on the Clinical Efficacy of Clopidogrel: A Systematic Review

目的系统评价CYP2C19*17多态性对服用氯吡格雷治疗的心血管疾病患者临床疗效的影响。方法计算机检索EMbase、PubMed、h e Cochrane Library、ClinicalTrials.gov、CBM、CNKI、WanFang Data和VIP数据库,查找有关CYP2C19*17多态性对氯吡格雷疗效影响的研究,检索时限均为建库至2012年10月。由2位研究者按照纳入与排除标准独立筛选文献、提取资料和评价质量后,采用RevMan 5.2软件进行Meta分析。结果最终纳入6篇文献共7个研究,包含12116例患者,其中CYP2C19*17携带者5578例,CYP2C19*17非携带者6538例。Meta分析结果显示:与CYP2C19*17非携带者相比,CYP2C19*17突变携带者服用氯吡格雷心血管事件发生风险降低[OR=0.85,95%CI(0.73,0.99),P=0.03],但出血性事件发生风险增加[OR=1.25,95%CI(1.05,1.50),P=0.01]。结论服用氯吡格雷治疗的CYP2C19*17基因突变心血管疾病患者,其心血管事件发生风险相对较低,但出血性事件发生风险相对较高。

Objective To evaluate anti-platelet effect of clopidogrel influenced by CYP2C19＊17 polymorphism in patients with cardiovascular disease. Methods We electronically searched EMbase, PubMed, The Cochrane Library, ClinicalTrials.gov, CNKI, CBM, WanFang Data and VIP databases for cohort studies about the anti-platelet effect of clopidogrel influenced by CYP2C19＊17 polymorphism in patients with cardiovascular disease from inception to October 2012. Two reviewers independently screened studies according to the inclusion and exclusion criteria, extracted data and evaluated the methodological quality of the included studies. Then meta-analysis was performed using the software Rev- Man 5.2. Results A total of seven studies involving 12 116 patients were finally included. Three were 5 579 CYP2C19＊17 carriers and 6 538 non-carriers. The results of meta-analyses showed that, compared with the CYP2C19＊17 non-carriers, lower rate of cardiovascular events （OR=0.85, 95%CI 0.73 to 0.99, P=0.03） and higher bleeding events （OR=1.25, 95%CI 1.05 to 1.50, P=0.01） were found in the CYP2C19＊17 carriers. Conclusion CYP2C19＊17 carriers is with lower cardiovas- cular events and higher bleeding events than the CYP2C19＊17 non-carriers.