CYP2C19基因型多态性与老年人冠状动脉介入术后氯吡格雷疗效的相关性

Association of CYP2C19 gene polymorphism with the efficacy of clopidogrel in elderly patients undergone percutaneous coronary intervention

目的探讨CYP2C19基因型多态性对老年急性冠状动脉综合征患者冠状动脉介入治疗术（PCI）后氯吡格雷抗血小板聚集疗效的影响。方法230例老年急性冠状动脉综合征行PCI术的患者，术后3d行血栓弹力图检查，吡啶二磷酸腺苷（ADP）诱导的血小板聚集抑制率〈30％则为氯吡格雷抵抗组78例，ADP诱导的血小板聚集抑制率〉30％则为非氯吡格雷抵抗组152例，比较两组基线资料、临床资料和CYP2C19基因型表型。结果230例患者服药后的ADP诱导的血小板抑制率CR组为（16．0±8．1）％，非CR组为（54．4±17．3）％。CYP2C19慢代谢基因型36例（15．6％），中间代谢基因型66例（28．7％），快代谢基因型128例（55．7％），中间代谢和快代谢基因型与慢代谢基因型比较，差异有统计学意义（均P〈0．05）。其中非CR组CYP2C19慢代谢、中间代谢、快代谢基因型分别为12例（33．3％）、46例（69．7％）、94例（73．4％），差异无统计学意义（χ2=0．35，P〉0．05）；CR组CYP2C19分别为24例（66．7％）、20例（30．3％）、34例（26．6％），差异有统计学意义（χ2=9．72，P〈0．01）。结论老年急性冠状动脉综合征患者PCI手术后CR发生率与CYP2C19基因多态性有关。

Objective To investigate the association of CYP2C19 gene polymorphism with the efficacy of clopidogrel in patients with acute coronary syndrome（ACS） after percutaneous coronary intervention（PCI）. Methods Thromboelastography was performed on 260 elderly ACS patients 3 days after PCI. Patients with the adenosine diphosphate（ADP） induced platelet aggregation inhibition rate 〈 30 % were assigned to the clopidogrel resistance group（ CR group, n= 78 ）, and those with the ADP-induced platelet aggregation inhibition rate 〉 30% were assigned to the non-clopidogrel resistance group （ non-CR group, n = 152 ） . Baseline data, clinical data, CYP2C19 genotype and phenotype were compared between the two groups. Results After drug treatment, the ADP-induced platelet aggregation inhibition rate was（ 16.0 ±8. 1 ） % for the CR group and（ 54.4 ±17.3 ） % for the non CR group. Of all 230 patients, 36 （ 15.6 % ） had the slow metabolic genotype, 66 （ 28.7 % ） had the intermediate metabolic genotype and 128 （55. 7 % ）had the fast metabolic genotype. The difference was statistically significant between the intermediate or fast metabolic genotype group and the slow metabolic genotype group （All P〈 0.05 ）. In the non-CR group, the slow, intermediate and fast metabolic genotype cases were 12 （33, 3% ） , 46 （69. 7% ）and 94 （73.4 % ） , respectively; There were no statistically significant differences between these groups（ χ2 = 0.35, P〉0.05 ）. In the CR group, the slow, intermediate and fast metabolic genotype cases were 24 （ 66. 7%） , 20 （30.3 %） and 34 （26.6 %）,respectively; There were statistically significant differences between these groups（ χ2= 9.72,P〈 0.01 ）. Conclusions The incidence of CR in elderly patients with acute coronary syndrome after PCI is closely related to the CYP2C19 gene polymorphism.