喀什地区某三甲医院心脑血管疾病患者CYP2C19基因的初步筛选

Initial Screening of CYP2C19 gene in Patients with Cardiocerebral Vascular Disease from A Three-A Hospital in Kashi Prefecture

目的:初步筛选喀什地区某三甲医院心脑血管疾病患者CYP2C19基因,为临床药师在氯吡格雷抵抗患者中开展药学监护提供参考。方法:根据CYP2C19基因代谢表型具有的基因多态性将其分为3组,通过基因芯片技术,对1 020例不同民族心脑血管疾病患者进行CYP2C19等位基因频率的筛查,指导个体化治疗,分析发生氯吡格雷抵抗的因素。结果:维吾尔族受试人群强代谢性纯合子占62.13%(497/800),汉族受试人群占42.72%(94/220),二者的差异有统计学意义(P<0.01);弱代谢性频率分布方面,维吾尔族受试人群占4.76%(38/800),远低于汉族受试人群的13.64%(30/220),二者的差异有统计学意义(P<0.01)。结论:汉族患者比维吾尔族患者更易受到CYP2C19基因多态性的影响,提示今后临床更应对汉族患者使用经CYP2C19代谢的药物氯吡格雷进行个体化给药,同时,可通过完善病例资料、调整给药剂量、慎重联合用药和采用新型抗血小板药等,开展药学监护。

OBJECTIVE： OBJECTIVE：To discuss the initial screening of CYP2C19 gene in patients with with＆nbsp;cardiocerebral vascular disease in a three.A hospital in Kashi prefecture for clinical pharmacist-s reference in carrying out pharmaceutical care for patients with clopidogrel resistance. METHODS：The patients were assigned to three groups based onpolymorphism of the metabolic phenotype of CYP2C19 gene. By means of GeneChip, 1020 patients of different nationality with cardiocerebral vascular disease were given screeening of CYP2C19 allele frequency, guidane on individualized therapy provided and analysis regarding the factors associated with clopidogrel resistance. RESULTS：62.13%（497/800）of the Uygur nationality subjects versus 42.72%（94/220）of the Han nationality subjects had strong metabolic homozygotes（P〈0.01）;4.76%（38/800）of the Uygur nationality subjects had weak metabolic homozygotes, which was much lower than that of the Han nationality subjects13.64%（30/220）,showing signficant differences between the two gorups（P〈0.01）. CONCLUSIONS：Han nationality subjects are more susceptible to the influence of CYP2C19 polymorphism, suggesting that it is more advisable to for clinical pharmacist adopt individualized therapy for Han nationality population in future use of clopidogrel that metabolized vial CYP2C19, and provide pharmaceutical care through improving clinical data,adjustig the dose,adopting combination therapy prudently and new antiplatelet drugs etc.