替格瑞洛与氯吡格雷在CYP2C19等位基因功能缺失患者中的抗血小板疗效比较

Efficacy of ticagrelor compared with clopidogrel for antiplatelet therapy in patients with lose-of-function CYP2C19 genotype

目的比较替格瑞洛与氯吡格雷在细胞色素P450 C19(CYP2C19)等位基因功能缺失的行冠状动脉介入治疗(PCI)的急性冠状动脉综合征(ACS)患者中应用的抗血小板疗效。方法选取行PCI的ACS患者,筛选CYP2C19等位基因功能缺失患者,包括*2/*2、*2/*3以及*3/*3。共入选患者52例,随机分为两组,每组26例。替格瑞洛组于PCI术前给予替格瑞洛180 mg负荷量后90 mg,po,bid;氯吡格雷组术前给予氯吡格雷300 mg负荷量后75 mg,po,qd。若是急诊PCI手术,替格瑞洛组于术前给予替格瑞洛180 mg负荷量后90 mg,po,bid;氯吡格雷组术前给予氯吡格雷600 mg负荷量后75 mg,po,qd维持。观察患者术后1年的主要心脑血管不良事件(MACCE)、出血情况及其他药物不良反应。结果两组患者基线资料无显著差异(P>0.05),应用血管紧张素转换酶抑制药/血管紧张素受体拮抗药、肾上腺素β受体阻滞药比例无显著差异(P>0.05)。术后1年,替格瑞洛组MACCE发生率为8%(2/26),低于氯吡格雷组(31%,8/26,P<0.05)。两组出血事件发生率分别为12%和8%,组间差异无显著意义(P>0.05)。结论 CYP2C19等位基因功能缺失患者给予替格瑞洛治疗可改善临床预后,基于CYP2C19基因型的个体化方案可考虑在行PCI术的ACS患者中实施。

AIM To compare the efficacy of antiplatelet therapy between ticagrelor and clopidogrel in acute coronary syndrome（ACS） patients with lose- of- function CYP2C19 genotype who undergoing percutaneous coronary intervention（ PCI）. METHODS ACS patients undergoing PCI were detected for CYP2C19 genotype.Patients with lose- of- function CYP2C19 genotype（including ＊2/＊2, ＊2/＊3 and ＊3/＊3） were selected. Fifty- two patients were enrolled and randomly divided into two groups and 26 patients in each group. Ticagrelor group were given ticagrelor（ 180 mg loading dose, 90 mg twice daily） before PCI while clopidogrel group were given clopidogrel（300 mg loading dose, 75 mg daily）. When the emergency PCI was needed, the ticagrelor group were given ticagrelor（180 mg loading dose, 90 mg twice daily） before emergency surgery and the clopidogrel group were given 600 mg clopidogrel loading dose before surgery and maintained with 75 mg daily. All patients were followed 12 months after PCI for main adverse cardiac and cerebral events（MACCE）, bleeding and other adverse drug reactions. RESULTS No significantly difference was found in baseline characters and the rates of combined medications（angiotensin- converting enzyme inhibitors/angiotensin receptor blockers and adrenergic β-receptor blockers） between two groups（P 〉0.05）. The MACCE occurred in fewer patients in the ticagrelor group than in the clopidogrel group（8%（2/26） vs. 31%（8/26）, P 〈0.05）. There was no difference in the rate of total bleeding between two groups（ 12% vs. 8%, P 〈0.05）. CONCLUSION Ticagrelor can improve clinic outcomes of patients with lose- of- function CYP2C19 genotype. Personalized treatment based on CYP2C19 genotype is considerable for ACS patients undergoing PCI.