CYP2C19多态性对动脉粥样硬化患者氯吡格雷疗效影响

The Effect of CYP2C19 Gene Polymorphism on Clopidogrel Efficacy in Patients With Atherosclerosis

目的探讨动脉粥样硬化患者CYP2C19基因多态性对氯吡格雷抗血小板效果的影响。方法选取105例因动脉粥样硬化接受氯吡格雷治疗的患者,在服用氯吡格雷7天后,采用焦磷酸测序检测其CYP2C19基因分型,分为快代谢型组、中代谢型组、慢代谢型组三组,并利用血栓弹力图检测比较不同代谢型组二磷酸腺苷(ADP)抑制率。结果在105例入组患者中,快代谢型组中患者ADP抑制率不达标(≤30%)比例为0%(0/47),中代谢型组22.5%(9/40),慢代谢型组100%(18/18),差异具有统计学意义(P<0.05)。结论 CYP2C19基因多态性与氯吡格雷对动脉粥样硬化患者短期疗效关系密切,快代谢型对氯吡格雷疗效无影响,中代谢型部分患者氯吡格雷治疗无效风险会有不同程度增加,而慢代谢型患者无效风险增加,建议改用其他抗血小板药物。

Objective To investigate the influence of CYP2C19 gene polymorphism on the antiplatelet effect of clopidogrel in patients with atherosclerosis （AS）. Methods A total of 105 patients with atherosclerosis treated with clopidogrel were enrolled. After 7 days of taking clopidogrel, the genotypes of CYP2C19 were detected by pyrosequencing. The genotypes of CYP2C19 were divided into fast metabolic group, moderate metabolic group, slow metabolic group, and thromboelastography was used to detect and compare adenosine diphosphate （ADP） inhibition rates in different metabolic groups. Results Among the 105 patients, the proportion of nonqualifed rate of ADP （ ≤30%） was 0% （0/47） in the fast metabolic group, 22.5% （9/40） in the metabolic group, 100% （18/18） in slow metabolic group, with a statistically signifcant diference （P 〈 0.05）. Conclusion CYP2C19 gene polymorphism and clopidogrel in patients with atherosclerosis are closely related to the short-term efcacy, fast metabolism has no efect on the efcacy of clopidogrel, inefective risk with clopidogrel treatment in some moderate metabolic patients increases in varying degrees, ineffective risk with clopidogrel treatment in slow metabolism patients increases significantly, it is recommended to switch to other anti-platelet drugs.