广州地区心血管病患者CYP2C19~* 1、CYP2C19~* 17基因多态性对氯吡格雷疗效的影响

Impact of CYP2C19~* 1 and CYP2C19~* 17 polymorphism on clopidogrel efficacy in patients with cardiovascular disease in Guangzhou

目的探讨广州地区汉族心血管病患者CYP2C19~* 1、CYP2C19~* 17基因多态性的频率分布及其对氯吡格雷疗效的影响。方法选取中山大学孙逸仙纪念医院2015年4月16日-2016年5月12日648例汉族心血管病住院患者,采用双探针实时荧光PCR法测定CYP2C19~* 1、CYP2C19~* 17基因型。选出符合纳入标准的167例,比较CYP2C19~* 1、CYP2C19~* 17基因型患者的血小板聚集率。结果广州地区汉族心血管病患者中CYP2C19~* 1~* 1基因频率为98.30%(637/648),CYP2C19~* 1~* 17基因频率为1.70%(11/648),无纯合突变。CYP2C19~* 1~* 17基因型患者服用氯吡格雷后血小板聚集率低于CYP2C19~* 1~* 1基因型组,差异有统计学意义(P<0.05)。结论广州汉族人群中,携带CYP2C19~* 17基因型的心血管病患者可增加出血的风险,基因检测有助于完善个体化合理用药。

Objective To evaluate the impact of CYP2C19＊1 and CYP2C19＊17 polymorphisms in the clopidogrel efficacy in patients with cardiovascular disease in Guangzhou. Methods 648 cases of hospitalized Han patients with cardiovascular disease were selected from Sun Yat-sen Memorial Hospital from April 16 th,2015 to May 12,2016. Determination of CYP2C19＊1 and CYP2C19＊17 polymorphisms was performed using double probe real-time fluorescence PCR,and 167 of them were selected in accordance with the inclusive criteria. Then we compared the platelet aggregation rate between CYP2C19＊17 alleles carriers and non-carriers. Results In Han patients with cardiovascular disease in Guangzhou,the CYP2C19＊1＊1 gene frequency was98. 30%（ 637/648）,CYP2C19＊1＊17 gene frequency was 1. 70%（ 11/648）,respectively,and homozygous mutation wasn＇t found. The platelet aggregation rate in CYP2C19＊1＊17 alleles carriers was lower than CYP2C19＊1＊1,with the differences statistically significant（ P 〈0. 05）. Conclusion Han patients with cardiovascular disease in Guangzhou carrying CYP2C19＊17allele should be aware of bleeding events when using clopidogrel. Genetic testing contributes to the improvement of individual rational drug use.