摘要
目的：描述中国西北地区汉族人群经皮冠状动脉介入（PCI）术后患者细胞色素P450（CYP2C19）基因多态性分布特点,并评价依据基因型指导PCI术后氯吡格雷抗血小板治疗的效果。方法：1入选2013年1月-7月在西京医院心内科行PCI的来自西北地区汉族患者2 117例行CYP2C19基因型检测,根据不同等位基因功能缺失分为快代谢基因型（＊1/＊1）、中间代谢基因型（＊1/＊2、＊1/＊3）和慢代谢基因型（＊2/＊2、＊2/＊3、＊3/＊3）;2从上述人群中选择临床资料完整的患者153例,按基因型分为2组：正常代谢组（快代谢基因型,59例）和弱代谢组（中间代谢和慢代谢基因型,94例）。正常代谢组患者术后口服氯吡格雷75 mg/d至1年,而弱代谢组氯吡格雷150 mg/d强化治疗1个月,后75 mg/d至1年抗血小板治疗;于术后1、3、6、9和12个月随访并记录和比较两组间主要不良心脑血管事件（MACE）发生情况。结果：1检测入选的2117例患者基因型结果显示,快代谢基因型（＊1/＊1）885例,发生率41.80%,中间代谢基因型（＊1/＊2、＊1/＊3）971例,发生率45.86%,其中＊1/＊2占39.16%,＊1/＊3占6.70%,慢代谢基因型（＊2/＊2、＊2/＊3、＊3/＊3）261例,发生率12.32%。2正常代谢组失訪6例,弱代谢组失訪5例,两组失訪率（9%vs.5%）差异未达到显著水平。正常代谢组和弱代谢组MACE发生率[12.3%（6/59）vs.10.1%（8/94）,两组差异也无统计学意义。结论：①入选患者CYP2C19等位基因突变频率发生率高,其中以＊1/＊2为主,2按基因型采取不同剂量的抗血小板药物后两组MACE发生率差异无统计学意义。
AIM： To investigate the correlation between the distribution of CYP2C19 polymorphisms and the effect of anti-platelet therapy in patients with acute coronary artery disease after percutaneous coronary intervention（ PCI）. METHODS： We selected 2117 patients diagnosed as having coronary heart disease and treated with PCI in Xijing Hospital. Gene polymorphisms were analyzed in the Han population in northwest China. Based on the loss of functional allele gene,the cases were divided into three gene types： fast metabolic genotypes（ ＊ 1 / ＊ 1）,intermediate metabolic genotypes（ ＊ 1 / ＊ 2,＊ 1 / ＊ 3） and slow metabolic genotypes（ ＊ 2 / ＊ 2,＊ 2 / ＊ 3 and ＊ 3 / ＊ 3）. One hundred and sixty-four cases with complete clinical data from the 2117 cases were divided into normal metabolic group（ fast metabolic genotype,n = 59） and poor metabolic group（ intermediary metabolism and slow metabolic genotype,n =94） and received anti-platelet therapy. The protocol was as follows： normal metabolism group was given oral clopidogrel 75 mg / d for 1 year and the poor metabolic group was given clopidogrel 150 mg / d of intensive treatment in the first month and 75 mg / d from the second month through the 12 th month. Major adver se cardiac / cerebrovascular events（ MACE） incidences were recorded and compared 1,3,6,9 and12 months between groups. RESULTS： According to gene type,885 cases（ 41. 80%） were fast metabolic genotype,971 cases（ 45. 86%） were intermediate metabolism genotype,and 261 cases（ 12. 32%） were slow metabolic genotype. Loss of follow-up was six cases and five cases,respectively,in normal metabolism group and poor metabolic group. For the effect of anti-platelet therapy,no statistically significant difference was observed in the incidence of MACE between normal metabolism group and poor metabolic group. CONCLUSION： The frequency of CYP2C19 allele mutation is high and mainly genotype ＊ 1 / ＊ 2in patients after PCI. There is no statistically significant difference in the incidence of MACE between normal metabolism group and poor metabolic group after different doses of anti-platelet therapy.
出处
《心脏杂志》
CAS
2015年第2期148-151,共4页
Chinese Heart Journal
