CYP2C19*2、*3无功能型等位基因对汉族与维吾尔族患者经皮冠状动脉支架植入术后使用氯吡格雷的疗效影响

Effect of the CYP2C19 * 2,* 3 non-functional allele on the curative effect of clopidogrel after PCI in Han and Uygur patients

目的:探讨携带CYP2C19*2、*3无功能型等位基因的汉族和维吾尔族患者经皮冠状动脉支架植入术(PCI)后口服氯吡格雷的疗效差异。方法:前瞻性纳入确诊为急性冠状动脉综合征并行PCI术患者400例,根据CYP2C19基因检测结果分为氯吡格雷正常代谢组(A组)与氯吡格雷弱代谢组(B组)。A组患者术后常规给予75 mg氯吡格雷,B组给予150 mg氯吡格雷。均随访(30±3)d,以再发急性心肌梗死、再发心绞痛、心源性猝死、支架内再血栓、非致死性卒中、致命性和危及生命出血事件为主要终点事件,以次要出血和轻微出血为次要终点事件,比较2组终点事件发生率。结果:A组中汉族患者与维吾尔族患者再发心肌梗死发生率(2.34%与1.47%)、再发心绞痛发生率(6.25%与5.88%)、心源性猝死(0.78%与0.00%)、支架内再血栓(1.56%与0.00%)及出血事件的发生率(5.47%与7.35%)差异均无统计学意义(P>0.05);B组中汉族患者与维吾尔族患者再发急性心肌梗死发生率(1.87%与0.00%)、再发心绞痛发生率(5.61%与4.76%)及出血事件的发生率(3.74%与4.76%)差异均无统计学意义(P>0.05),且均无心源性猝死、支架内再血栓、非致死性卒中、致命性与危及生命出血事件发生。2组维吾尔族患者再发急性心肌梗死发生率(0.00%与1.47%)、再发心绞痛发生率(4.76%与5.88%)及出血事件发生率(4.76%与7.35%)差异均无统计学意义(P>0.05),且均无心源性猝死、支架内再血栓、非致死性卒中、致命性与危及生命出血事件发生。结论:携带CYP2C19*2、*3无功能型等位基因的维吾尔族患者口服150 mg/d氯吡格雷可减弱氯吡格雷抵抗,有效减少主要心血管事件发生率,且不增加出血风险。

Objective： To compare the effects of the CYP2C19 ＊ 2,＊ 3 non-functional allele on the curative effect of clopidogrel after percutaneous coronary stent implantation（ PCI） between Han and Uygur patients. Methods： Four hundred acute coronary syndrome patients treated with PCI were divided into the clopidogrel normal metabolish group（ group A） and weak clopidogrel normal metabolish group（ group B） according to the result of CYP2C19 genetic testing. The group A and group B were treated with 75 mg and 150 mg of clopidogrel,respectively. Two groups were followed up for（ 30 ± 3） d. The recurrences of the acute myocardial infarction,angina,cardiac death,stent thrombosis,nonfatal stroke,fatal and life-threatening bleeding were the primary endpoint events,and the minor bleeding and slight bleeding were the secondary endpoint events. The incidence of the endpoint event between two groups were compared. Results：The differences of the recurrence rate of the acute myocardial infarction（ 2. 34% and 1. 47%）,angina（ 6. 25% and 5. 88%）,cardiac death（ 0. 78% and 0. 00%）,stent thrombosis（ 1. 56% and 0. 00%）,and bleeding（ 5. 47% and 7. 35%） between Han and Uygur patients in group A were not statistically significant（ P〉0. 05）. The differences of the recurrence rate of the acute myocardial infarction（ 1. 87% and 0. 00%）,angina（ 5. 61% and 4. 76%） and bleeding（ 3. 74% and 4. 76%） between Han and Uygur patients in group B were not statistically significant（ P〉0. 05）,and the cardiac death,stent thrombosis,nonfatal stroke,fatal and life-threatening bleeding were not found in Han and Uygur patients of group B. The differences of the recurrence rate of the acute myocardial infarction,angina and bleeding in Uygur patients between group A and group B were not statistically significant（ P〉0. 05）,and the cardiac death,stent thrombosis,nonfatal stroke,fatal and life-threatening bleeding were not found in Uygur patients of group A and group B. Conclusions：Among Uighur patients with the CYP2C19＊ 2,＊ 3 non-functional allele,the treatment of 150 mg of clopidogrel per day can weaken the clopidogrel resistance,effectively reduce the incidence of major cardiovascular events,and does not increase the risk of bleeding.