CYP2C19指导ACS行PCI患者抗血小板药物选择的研究

Selection of anti-platelet drug in patients with acute coronary syndrome after percutaneous coronary intervention guided by CYP2C19 examination

目的:根据急性冠状动脉综合征(ACS)行经皮冠状动脉介入治疗(PCI)患者CYP2C19基因型的不同选择抗血小板药物及剂量进行治疗,观察其抗血小板效应及出血风险,为个体化抗血小板药物的选择提供参考。方法:入选231例行PCI的ACS患者并检测其CYP2C19基因型,根据基因型的不同分为快代谢组(CYP2C19*1/*1)、中代谢组(CYP2C19*1/*2、CYP2C19*1/*3)、慢代谢组(CYP2C19*2/*2、CYP2C19*3/*3、CYP2C19*2/*3),并分别给予快代谢组常规双联抗血小板治疗(氯吡格雷75mg qd+阿司匹林100mg qn),中代谢组氯吡格雷剂量加倍(氯吡格雷150mg qd+阿司匹林100mg qn),慢代谢组换用新型抗血小板药物(替格瑞洛90mg bid+阿司匹林100mg qn),比较各组用药3个月后血小板抑制率变化情况及出血事件的发生情况。结果:根据基因型所分3组的临床基线资料及PCI结果无统计学差异。中代谢组及慢代谢组患者用药3个月后,血小板抑制率均较快代谢组血小板抑制率升高,慢代谢组血小板抑制率较中代谢组明显升高,差别具有统计学意义(均P<0.05)。结论:PCI术后的ACS患者中,携带CYP2C19*2、CYP2C19*3等位基因的高危患者,采用氯吡格雷剂量加倍及换用替格瑞洛均可充分抑制血小板,且换用替格瑞洛优于氯吡格雷剂量加倍。

Objective：To provide references to select antiplatelet drugs and doses for treatment according to the different genotype of patients with acute coronary syndrome（ACS）after PCI,and observe the anti-platelet effect and bleeding risk.Method：We selected 231 patients with ACS after PCI and detect theirCYP2C19 genotype.According to the different genotype,we divided them into fast metabolism group（CYP2C19＊1/＊1）,metabolic group（CYP2C19＊1/＊2,CYP2C19＊1/＊3）,and slow metabolism group（CYP2C19＊2/＊2,CYP2C19＊3/＊3,CYP2C19＊2/＊3）.Then,we respectively gave conventional dual antiplatelet therapy for fast metabolism group（Clopidogrel 75 mg qd＋ Aspirin 100 mg qn）,double dose of clopidogrelfor metabolic group（Clopidogrel150mg qd＋Aspirin 100 mg qn）,new anti-platelet drugs for slow metabolism group（Ticagrelor90mg bid＋Aspirin100mg qn）.Then,we compared conventional program of each group by using TEG to detect the platelet inhibition rate changes after the new medication program was used for 3 months.The adverse cardiovascular events and bleeding events were followed-up and compared among each group.Result：There is no significant difference in clinical baseline data of 3group that were divided according genotypes and PCI result.Compared with patients who used conventional treatment options,the patients who are in the metabolic group using double dose of clopidogrel and patients in slow metabolism group using new anti-platelet drugs,the ADP of patients in slow metabolism group using new anti-platelet drugs increased more obviously than the ADP of patients who are in the metabolic group using double dose of clopidogrel.The difference was statistically significant.Conclusion：After PCI,the treatment of using double dose of clopidogrel and ticagrelor can sufficiently inhibit platelet for ACS patients with CYP2C19＊2、CYP2C19＊3allele,but using of ticagrelor better than double dose of clopidogrel.