基因检测在急性冠脉综合征患者PCI术后个体化抗血小板治疗中的应用

Application of Genetic Testing in Individualized Antiplatelet Therapy for Acute Coronary Syndrome Patients after Percutaneous Coronary Intervention

目的:探讨基因检测在急性冠脉综合征(ACS)患者经皮冠状动脉介入治疗(PCI)术后氯吡格雷个体化抗血小板治疗中的应用价值。方法:临床药师参与3例ACS患者PCI术后抗血小板治疗,综合分析其病变复杂程度、支架长度及数量、并发症、吸烟史等发生支架内血栓的危险因素,建议行氯吡格雷相关基因[细胞色素P450(CYP)2C19、对氧磷酶1(PON1)、三磷酸腺苷结合盒亚家族B成员1(ACBC1)等]检测,并根据检测结果分别提出更换其他类别的抗血小板药、维持原治疗方案并增加监测强度等建议。结果:医师采纳临床药师建议。综合基因检测结果及患者临床因素优化抗血小板治疗方案后,3例患者病情稳定,均带药出院。结论:基因检测可为ACS患者PCI术后个体化抗血小板治疗方案的制订提供依据,可作为临床药师开展药学服务的切入点之一。临床药师在进行基因检测时,应对ACS患者进行血栓风险评估,选择适宜的检测人群;同时应在基因检测的基础上,综合评估患者的用药依从性、支架内血栓风险、药物疗效及不良反应等临床因素和循证药学证据,优化抗血小板治疗方案,以保证用药的安全、有效。

OBJECTIVE：To investigate the value of genetic testing in clopidogrel individualized antiplatelet therapy for acute coronary syndrome（ACS） patients after percutaneous coronary intervention（PCI）. METHODS：Clinical pharmacists participated in therapy for 3 ACS patients after PCI,and analyzed risk factors of stent thrombosis as the degree of lesion complexity,length and number of stents,complication,smoking history,etc. Clinical pharmacists suggested conducting clopidogrel genetic testing（CYP2C19,PON1,ACBC1）,and suggested replacing antiplatelet agents,maintaining original plan and strengthening monitoring according to the results of genetic testing. RESULTS：The physicians adopted the suggestions of clinical pharmacists. After optimizing antiplatelet therapy according to the results of genetic testing and clinical factors,3 patients were stable and discharged from hospital with drugs. CONCLUSIONS：Genetic testing can provide evidence for the formulation of individualized antiplatelet therapy in ACS patients after PCI,and can be regarded as one of the breakthrough points for clinical pharmacists to carry out pharmaceutical care. In conducting genetic testing,clinical pharmacists should evaluate the risk of thrombosis in ACS patients and select the appropriate population for testing. At the same time,the clinical factors as medication compliance,stent thrombosis risk,therapeutic efficacy,ADR,and evidence-based pharmaceutical evidence should be comprehensively evaluated on the basis of genetic testing,and antiplatelet therapy plan should be optimized so as to guarantee the safety and effectiveness of drug use.