蒙古族PCI病人CYP2C19基因多态性与氯吡格雷抵抗相关性研究

RELATIONSHIP OF CYP2C19GENE POLYMORPHISMS AND CLOPIDOGREL RESISTANCE IN THE PATIENTS WITH PCI IN MONGOLIAN POPULATION

目的:研究内蒙古自治区西部蒙古族经皮冠状动脉介入治疗术(percutaneous coronary intervention,PCI)病人CYP2C19基因多态性与氯吡格雷抵抗的相关性,为蒙古族病人临床个体化治疗提供依据。方法:选取2013-10~2016-09在内蒙古医科大学附属医院急诊内科接受PCI治疗的蒙古族冠心病病人83例进行CYP2C19基因型检测,并按照基因型进行分组,比较平均血小板聚集率降低情况、氯吡格雷抵抗和随访12mo不良心血管事件的再发生情况。结果:(1)入选病人的各基因型分布为快代谢型基因组(*1/*1)32例,占总例数38.6%;中间代谢型基因组(*1/*2、*1/*3)为35例,占总例数42.1%;慢代谢型基因组(*2/*2、*2/*3、*3/*3)共16例,占总例数19.2%。(2)快代谢型基因型组出现氯吡格雷抵抗率(15.6%)明显低于中间代谢型基因组(32.4%)及慢代谢型基因组(43.8%),P<0.05;快代谢型基因组平均血小板聚集降低率(20.76±12.11)%明显高于中间代谢型基因组(15.44±9.38)%及慢代谢型基因组的(13.83±11.43)%,P<0.05;快代谢型基因组的心血管不良事件发生率(25.0%)明显少于中间代谢型基因组(48.6%)及慢代谢型基因组(64.2%),P<0.05。结论:用氯吡格雷治疗蒙古族PCI病人过程中CYP2C19基因多态性对其疗效具有明显影响作用,应根据病人基因型制定个性化治疗方案。

Objective： To investigate the relationship of CYP2C19gene polymorphisms and clopidogrel resistance in Chinese Mongolian population patients from western Inner Mongolia who accepted percutaneous coronary intervention （PCI）. Methods：To selecte 83 cases of coronary heart disease （CHD） patients who accepted PCI in emergency medicine of Inner Mongolia medical university affiliated hospital and detect CYP2C19gene. According to the different genotypes, the patients were divided into different groups, to compare the average platelet aggregation rate between difierent genotype groups, clopidogrel resistance reduction and followed up for 12months of adverse cardiovascular events happening again. Results： （ 1 ） For the genotype distribution of fast metabolism in patients with genotype （ ＊ 1/＊ ! ）has 32 cases, accounted for 38.6%, intermediate metabolism genotype（ ＊ 1/＊ 2, ＊ 1/＊ 3 ） has 35 cases, accounted for 42.1% , slow metabolism genotype （ ＊ 2/＊ 2, ＊ 2/＊ 3, ＊ 3/＊ 3 ） has 16 cases, accounted for （ 19.2% ） ; （2） After treatment with clopidogrel, the group of fast metabolism genotype which has clopidogrel resistance rate（ 15.6% ）was lower than that in group intermediary metabolism genotype （ 32.4% ） and slow metabolism genotype （43.8%）, P〈0.05 ; The average reduce platelet aggregation rate of fast metabolism group（20.76＋12.11 ）% is significantly higher than the intermediary metabolism genotype （15.44 ＋9.38 ）% and slow metabolism genotype （ 13.83 -＋ 11.43 ） %, P 〈 0.05 ; The incidence of adverse cardiovascular events （ 25.0% ） in fast metabolism group was obviously less than the intermediary metabolism genotype（gS. 6% ）and slow metabolism genotype （ 64.2% ） , P 〈 0.05. The difference was statistically significant. Conclusion ： The CYP2C19gene polymorphisms has obvious effect on curative effect in the Mongolian PCI patients treated by clopidogrel, we should make individualized treatment plan according to the genotype of patients.