CYP2C19基因多态性检测指导急性非STEMI患者PCI术后氯吡格雷个性化用药研究

Investigation of suggesting individualized use of clopidogrel in post-coronary intervention patients suffering from acute non-ST-segment elevation myocardial infarction by detecting CYP2C19 gene polymorphism

目的研究CYP2C19基因多态性检测指导急性非ST段抬高心肌梗死(STEMI)患者经皮冠状动脉介入治疗(PCI)术后氯吡格雷个性化用药情况。方法选取102例择期行PCI术治疗的STEMI患者作为研究对象,通过基因芯片检测技术对CYP2C19基因多态性进行检测,并根据相关检测结果给予患者用药建议及比较不同基因型的不良终点事件情况。结果在102例患者中,快代谢型47例(46. 08%),建议给予常规剂量的氯吡格雷治疗;中代谢型41例(40. 20%),建议加大氯吡格雷用药剂量治疗;慢代谢型14例(13. 73%),建议更换抗血小板药物替格瑞洛治疗。随访8个月,慢代谢型组再发心肌缺血或梗死率高于快代谢型组和中代谢型组(P <0. 01);慢代谢型组脑血管意外发生率高于快代谢型组(P <0. 01)和中代谢型组(P <0. 05);中代谢型组再发心肌缺血或梗死率、脑血管意外发生率与快代谢型组比较,差异均无统计学意义(P>0. 05);三组均未发生心源性死亡、支架内血栓形成、大出血等不良终点事件。结论不同患者其CYP2C19基因型存在差异,可导致应用氯吡格雷的疗效不同,故应根据患者不同基因型制定相应的治疗方案,切勿盲目用药。

Objective To explore suggesting individualized use of clopidogrel after percutaneous coronary intervention（PCI）for acute non-ST-segment elevation myocardial infarction（STEMI）by detecting CYP2C19 gene polymorphism. Methods A total of 102 patients diagnosed as STEMI patients who underwent PCI were administrated with gene chip detection technique to detect the CYP2C19 gene polymorphism,in order to suggest clopidogrel dosage and compare the adverse events of different genotypes according to the test results. Results Of the 102 cases,47 cases（46.08%）of fast metabolic type received conventional dose of clopidogrel,41 cases（40.20%）of middle metabolic type had large dosage of clopidogrel,14 cases（13.73%）of slow metabolic type took antiplatelet drug ticagrelor instead of clopidogrel.After 8-month follow-up,the higher rate of recurrent myocardial ischemia or infarction appeared in the slow metabolic group compared with the fast metabolic group and the medium metabolic group（ P 〈0.01）,and the slow metabolic group exhibited higher incidence of cerebrovascular accident than the fast metabolic group（ P 〈0.01）and the medium metabolic group（ P 〈0.05）.However,no significant difference in the rate of recurrent myocardial ischemia or infarction and cerebrovascular accident incidence existed between the medium metabolic group and fast metabolic group （ P 〉0.05）.No adverse cardiac events such as cardiac death,stent thrombosis,massive bleeding occurred in all the cases. Conclusion There are different CYP2C19 genotypes in different patients,which can lead to the different effects of clopidogrel.Therefore,the corresponding interventions should be made according to the patient’s genotypes in order to avoid using drug blindly.