CYP2C19基因多态性对冠心病患者经皮冠状动脉介入治疗后氯吡格雷抗血小板聚集效果的影响研究

Impact of CYP2C19 Gene Polymorphism on Anti-platelet Aggregation Effect of Clopidogrel in Coronary Heart Disease Patients Treated by PCI

目的探讨CYP2C19基因多态性对冠心病患者经皮冠状动脉介入治疗(PCI)后氯吡格雷抗血小板聚集效果的影响。方法选取2017年1—10月武汉大学人民医院心内科收治的冠心病患者116例,按照CYP2C19基因多态性分为快代谢型组47例、中代谢型组53例、慢代谢型组16例。3组患者均于PCI后常规给予阿司匹林肠溶片100 mg/d、氯吡格雷150 mg/d维持治疗。比较3组患者一般资料、实验室检查指标及治疗前和治疗后1周最大血小板聚集率。结果 3组患者男性比例、年龄、吸烟史、饮酒史、糖尿病发生率、高血压发生率、高脂血症发生率、心肌梗死发生率比较,差异无统计学意义(P>0.05)。3组患者总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白(HDL)、低密度脂蛋白(LDL)、极低密度脂蛋白(VLDL)、纤维蛋白原(FIB)、血小板计数(PLT)、心肌肌钙蛋白I(c Tn I)比较,差异无统计学意义(P>0.05)。治疗前3组患者最大血小板聚集率比较,差异无统计学意义(P>0.05);治疗后1周,慢代谢型组与中代谢型组患者最大血小板聚集率高于快代谢型组(P<0.05);但中代谢型组与慢代谢型组患者最大血小板聚集率比较,差异无统计学意义(P>0.05)。结论 CYP2C19基因型为中慢代谢型可降低冠心病患者PCI后氯吡格雷抗血小板聚集效果,进而增加不良心血管事件发生风险。

Objective To investigate the impact of CYP2 C19 gene polymorphism on anti-platelet aggregation effect of clopidogrel in coronary heart disease patients treated by PCI. Methods From January to October 2017, a total of 116 patients with coronary heart disease were selected in the Department of Cardiovascular Medicine, the People＇s Hospital of Wuhan University, and they were divided into fast metabolic group（n=47）, moderate metabolic group（n=53） and slow metabolic group（n=16）. Patients in the three groups received aspirin enteric-coated tablets（100 mg/d） and clopidogrel（150 mg/d） for maintenance therapy. General information, laboratory examination results, maximum platelet aggregation rate before treatment and 1 week after treatment were compared in the three groups. Results No statistically significant differences of male proportion, age, smoking history, drinking history, incidence of diabetes, hypertension, hyperlipidaemia or myocardial infarction was found in the three groups（P〉0.05）. No statistically significant differences of TC, TG, HDL, LDL, VLDL, FIB, PLT or c Tn I was found in the three groups（P〉0.05）.No statistically significant differences of maximum platelet aggregation rate was found in the three groups before treatment（P〉0.05）; 1 week after treatment, maximum platelet aggregation rate in moderate metabolic group and slow metabolic group was statistically significantly higher than that in fast metabolic group（P〈0.05）, while no statistically significant differences of maximum platelet aggregation rate was found between moderate metabolic group and slow metabolic group（P〉0.05）.Conclusion Moderate and slow metabolic genetype of CYP2 C19 can reduce the anti-platelet aggregation effect of clopidogrel in coronary heart disease patients treated by PCI, increase the risk of adverse cardiac events.