CYP2C19基因型检测指导P2Y12受体阻滞剂应用的研究进展

Research Progress on the Application of P2Y12 Inhibitor Guided by CYP2C19 Genotype Detection

急性冠脉综合征(Acute coronary syndrome,ACS)是全球范围内引发猝死的主要原因,其发生是由于血小板聚集引起冠脉急性闭塞所致。阿司匹林和氯吡格雷已经成为ACS及经皮冠状动脉介入治疗(Percutaneous coronary intervention,PCI)术后患者抗栓治疗的基石,防止PCI术后发生主要不良心血管事件(Major adverse cardiovascular events,MACE)。然而,尽管接受阿司匹林及氯吡格雷双联抗血小板治疗,部分患者仍可再发缺血性心血管事件,考虑存在抗血小板药物抵抗。研究表明,亚洲人群中氯吡格雷抵抗(Clopidogrel resistance,CR)发生率较高,且受多种因素影响,其中基因多态性起着至关重要作用。全面了解不同基因型对氯吡格雷反应的差异,结合血小板聚集率检测,合理选择P2Y12受体阻滞剂,可以显著改善ACS患者预后。

Acute coronary syndrome （ACS） is the leading cause of sudden death in the world. It is acute occlusion of coronary arteries caused by platelet aggregation. Dual anti-platelet therapy which is made up of aspirin and clopidogrel is still the mainstay phar- macologic therapy to prevent the occurrence of major adverse cardiovascular events （MACE） after percutaneous coronary intervention （PCI）. However, there remains a risk of recurrent ischemic events that is related to clopidogrel resistance （CR）. Previous studies showed that the incidence of CR is relatively high in Asian population and it is affected by many factors. One of the most important factors is gene polymorphism. It is important to have a comprehensive understanding about how different CYP2C19 gene polymorphism responds to clopidogrel. Combined with platelet aggregation test, the application of CYP2C 19 gene polymorphism detection may better guide the use of P2Y12 inhibitor and then significantly improve clinical outcomes.