MDR1基因多态性对心肌梗死患者介入术后氯吡格雷抵抗及临床预后的影响

Influence of MDR1polymorphism on clopidogrel resistance and prognosis in patients with myocardial infarction treated with percutaneous coronary intervention

心肌梗死是由于冠状动脉（冠脉）闭塞、血流中断,使部分心肌因严重的持久性缺血而发生局部坏死。近年来支架植入术可持续、有效地开放梗死相关血管,从而降低了死亡率、再梗死及卒中等主要心血管事件的发生。但术后抗血小板治疗因个体差异,可出现抗血小板药物抵抗,引发血栓事件。如何进行术后抗血小板个体化治疗成为近几年国内外研究热点。

A total of 235 middle-aged and elderly myocardial infarction patients treated with PCI were divided into clopidogrel resistance group and control group according to the results of platelet aggregation on the 2nd post operative day.All patients have taken antiplatelet medications for three days prior to the operation,and then received follow-up for one year.Genotype of C3435 T and C1236 T were analyzed with restriction endonuclease digestion and sequencing.Compared with the C allele frequency of the MDR1 C3435 T,T allele frequency was significantly higher in CR group than in NCR group（49%vs 31%）.T allele was associated with clopidogrel resistance（χ-2=14.22,P〈0.05）,and in the follow-up studies,patients carrying the homozygous CC genotype were more likely to have risk of clinical bleeding events compared with CT and TT carriers（P〈0.05）.No correlation was found between C1236 T polymorphism and clopidogrel resistance or prognosis.