回顾性分析氯吡格雷弱代谢患者的抗血小板治疗现状

Retrospective analysis on antiplatelet therapy status in patients with clopidogrel poor metabolizers

目的筛查氯吡格雷弱代谢型急性冠脉综合征患者,回顾性分析其抗血小板治疗现状。方法选取医院收治的285例陕西汉族急性冠脉综合征患者,通过焦磷酸测序技术检测CYP2C19*2和CYP2C19*3基因多态性筛查氯吡格雷弱代谢患者,分析其抗血小板治疗现状。结果在285例患者中,快代谢型占38.6%,中间代谢型占49.1%,慢代谢型占12.3%,后两者为弱代谢型(61.4%)。中间代谢型患者,53.6%应用氯吡格雷75mg·d^(-1);46.4%调整治疗方案,如氯吡格雷剂量加倍至150mg·d^(-1),更换替格瑞洛或三联疗法(加用西洛他唑)。慢代谢型患者,54.3%应用氯吡格雷75mg·d^(-1),45.7%调整为上述治疗方案,其中28.5%更换替格瑞洛。结论在陕西汉族急性冠脉综合征患者中,氯吡格雷弱代谢型发生率高,目前个体化抗血小板治疗方案并无统一规范。

Objective To identify the clopidogrel poor metabolizers with acute coronary syndrome（ACS）and to retrospectively analyze the antiplatelet therapy status.Methods 285 Shaanxi Han Chinese with（ACS）in the hospital were enrolled in this study.The pyrophosphate sequencing technology was used to detect CYP2C19＊2and CYP2C19＊3gene polymorphism.Antiplatelet therapy status of clopidogrel poor metabolizers with ACS was analyzed.Results The rapid,intermediate and slow metabolizers were respectively 38.6%,49.1% and 12.3%.The intermediate and slow metabolizers were regarded as clopidogrel poor metabolizers（61.4%）.About 53.6%clopidogrel intermediate metabolizers were given conventional dose of clopidogrel（75mg·d^-1）,46.4% cases were applied the adjusted treatment plans including doubling dosage of clopidogrel（150 mg·d^-1）,replacement drugs（such as ticagrelor）or triple antiplatelet therapy（adding cilostazol）.For clopidogrel slow metabolizers,54.3% cases were still given conventional dose of clopidogrel（75mg·d^-1）,45.7% patients were administered the adjusted treatment plans as mentioned above,28.8% of patients with replacement of ticagrelor.Conclusion The incidence of clopidogrel poor metabolizers is high in Shaanxi Han Chinese population with ACS.There is no uniform standard that individualized antiplatelet treatment of clopidogrel poor metabolizers.