细胞色素P450酶2C19基因多态性与血小板高反应性相关性的研究

Association between CYP2C19 gene polymorphism and high platelet reactivity

目的探讨急性冠状动脉综合征患者PCI术后细胞色素P450酶2C19(CYP2C19)基因多态性与血小板高反应性(HTPR)的相关性。方法选择急性冠状动脉综合征并接受PCI术的患者304例,根据二磷酸腺苷诱导的最大血小板聚集率是否大于50%分为HTPR组73例,非HTPR组231例。行CYP2C19*2、CYP2C19*3基因型检测,根据检测结果分为快代谢型、中间代谢型和慢代谢型。并利用最大血小板聚集率评价患者的血小板反应性。统计学分析CYP2C19基因多态性对血小板反应性的影响。结果 HTPR组快代谢型基因比例明显低于非HTPR组(28.8%vs 57.6%,P<0.05),慢代谢型基因比例明显高于非HTPR组(13.7%vs 3.9%,P<0.01)。慢代谢型患者最大血小板聚集率明显高于快代谢型和中间代谢型患者[(76.3±11.3)%vs(35.4±14.2)%和(45.1±15.8)%,P<0.05]。结论 CYP2C19基因多态性对服用氯吡格雷患者的HTPR具有一定影响。慢代谢型患者最大血小板聚集率显著高于快代谢型和中间代谢型患者。

Objective To study the association between CYP2C19 gene polymorphism and high ontreatment platelet reactivity（HTPR）in acute coronary syndrome（ACS）patients after PCI.Methods Three hundred and four ACS patients after PCI were divided into HTPR group（n=73）and non-HTPR group（n=231）according to whether the maximum platelet aggregation rate induced by ADP was〉50%.The detected genotypes of CYP2C19＊2and CYP2C19＊3were divided into rapid metabolic type,intermediate metabolic type and slow metabolic type.The platelet reactivity in ACS patients was assessed according to the HTPR.The effect of CYP2C19 gene polymorphism on platelet reactivity was analyzed by statistical analysis.Results The proportion of rapid metabolic genotype was significantly lower in HTPR group than in non-HTPR group（28.8% vs 57.6%,P〈0.05）and was significantly higher in slow metabolic genotype than in non-HTPR group（13.7%vs 3.9%,P〈0.01）.The maximum platelet aggregation rate was significantly higher in slow metabolic genotype than in rapid and intermediate metabolic genotypes（76.3%±11.3%vs35.4%±14.2%,76.3% ±11.3% vs45.1% ±15.8%,P〈0.05）.Conclusion CYP2C19 gene polymorphism exerts its effect on HTPR in patients receiving clopidogrel treatment.The maximum platelet aggregation rate is significantly higher in slow metabolic genotype patients than in rapid and intermediate metabolic genotype patients.