细胞色素CYP2C19*2基因多态性对冠心病氯吡格雷服用者预后影响的Meta分析

Association between CYP2C19*2 polymorphism and clinical prognosis in coronary artery disease patients treated with clopidogrel:a Meta-analysis

目的系统评价细胞色素CYP2C19＊2基因多态性对服用氯吡格雷的冠心病患者的临床预后影响。方法通过检索Pubmed、EMBASE、Scopus、Cochrane图书馆、中国生物医学文献数据库（SinoMed）、万方数字化期刊全文数据库中公开发表的相关文献,由2名研究者独立筛选和评价,利用RevMan5.1软件进行统计学分析。结果参考16篇文献,共计14 674例受试者。与CYP2C19＊2基因非携带者相比,携带者发生不良心血管事件（OR=1.58,95%CI：1.19-2.10）、支架内血栓形成（OR=2.92,95%CI：2.10-4.08）、心肌梗死（OR=1.62,95%CI：1.35-1.95）、脑卒中（OR=2.12,95%CI：1.34-3.36）的风险较高（P〈0.01）,再次接受血运重建术的比例较高（OR=1.27,95%CI：1.03-1.57,P〈0.01）;二者出现死亡或出血的发生率差异无统计学意义（P〉0.05）。结论 CYP2C19＊2基因多态性与服用氯吡格雷的冠心病患者的临床预后相关,CYP2C19＊2基因携带者患心血管疾病的风险更高。

Objective To evaluate the impact of cytochrome CYP2C19＊2polymorphism on clinical prognosis of coronary artery disease patients treated with clopidogrel.Methods Articles reporting the association between CYP2C19＊2polymorphism and clinical prognosis in clopidogrel-treated patients were selected from Pubmed,EMBASE,Scopus,Cochrane Library,SinoMed and Wan Fang Digital Journal Database.Literature review and data extraction were completed by two investigators independently.All statistical tests were performed with RevMan5.1.Results Sixteen researches with 14 674 participants were included.CYP2C19＊2carriers presented an increased risk of adverse cardiovascular events（OR=2.92,95%CI：2.10-4.08）,myocardial infarction（OR=1.62,95%CI：1.35-1.95）,stroke（OR=2.12,95%CI：1.34-3.36,P〈0.01）and revascularization（OR=1.27,95%CI：1.03-1.57,P〈0.01）than non-carriers.No significant differences were found in mortality and risk of bleeding between the two groups（P〈0.05）.Conclusion CYP2C19＊2polymorphism is associated with the clinical prognosis of coronary artery disease patients treated with clopidogrel.CYP2C19＊2carriers have an increased risk of adverse cardiovascular events.