CYP2C19基因多态性检测指导非ST段抬高急性冠状动脉综合征患者经皮冠状动脉介入治疗术后抗血小板药物应用的临床随访研究

The short and long term follow-up results of CYP2C19 gene polymorphisms screening guided antiplatelet therapy after percutaneous coronary intervention on non ST-segment elevation acute coronary syndrome patients

目的对经皮冠状动脉介入治疗(PCI)的非ST段抬高急性冠状动脉综合征(NSTEACS)患者进行CYP2C19基因多态性检测,判明有无氯吡格雷药物代谢异常,指导PCI术后选择性应用抗血小板药物,随诊观察术后1个月及6个月的主要不良心血管事件(MACE),明确基因检测指导的治疗作用。方法 2013年5月至2014年5月大连医科大学附属第一医院心内科收治NSTE-ACS并接受PCI治疗的患者486例,连续分为CYP2C19基因多态性检测指导治疗组(A组237例,若呈氯吡格雷低代谢,则用替格瑞洛替换治疗)与常规治疗组(B组249例,PCI术后常规应用氯吡格雷治疗),分析两组患者术后1个月、6个月MACE发生情况。结果 A组237例患者中,43例(18.1%)基因检测为氯吡格雷低代谢,改用替格瑞洛治疗。术后1个月时总体MACE发生率A组显著低于B组(1.3%比5.2%,P=0.031),A组心肌梗死和死亡的总发生率显著低于B组(1.3%比3.6%,P=0.041)。术后6个月时,两组总体MACE发生率比较,差异无统计学意义(4.2%比6.8%,P=0.210),但A组仍保持较低趋势。结论接受PCI治疗的NSTE-ACS患者术后进行CYP2C19基因多态性检测,有助于对氯吡格雷低代谢患者进行针对性替换治疗,从而有效降低这部分患者术后1个月的临床MACE发生率,但是对于远期预后的影响需做进一步观察。

Objective To evaluate the CYP2C19 gene polymorphisms screening guided antiplatelet therapy after percutaneous coronary intervention（ PCI） in patients with non ST-segment elevation acute coronary syndrome（ NSTE-ACS）. Methods From May 2013 to May 2014,a total of 486 patients with NSTE-ACS undergoing PCI were sequentially randomized into CYP2C19 gene polymorphisms screening group（ n = 237,group A）,and without CYP2C19 gene polymorphisms screening group（ n = 249,group B）. Ticagrelor was given instead of clopidogrel therapy in patients with low concentration of active metabolite of clopidogrel during 6 months clinical follow up. The MACE rates were analyzed at 1 month and 6 months in clinical follow up. Results In group A,there are 43 patients（ 18. 1%） among 237 patients showed low concentration of active metabolite of clopidogrel by CYP2C19 gene polymorphisms screening,and Ticagrelor was given instead of Clopidogrel after PCI. At 1 month follow up,acute myocardial infarction and death rate in group B were greater than in group A（ 5. 2% vs. 1. 3%,P = 0. 031）. At 6 months follow-up,the MACE rate was no significant different between the 2 groups（ group A 4. 2% vs. group B 6. 8%,P =0. 210）. Conclusions The CYP2C19 gene polymorphisms screening guided anti-platelet therapy is beneficial to those patients with low concentration of active metabolite of clopidogrel at 1 month in patients with NSTE-ACS undergoing PCI.