贵州省遵义地区经皮冠状动脉治疗术后患者CYP2C19基因多态性与氯吡格雷疗效的相关性研究

Correlation of CYP2CI9 polymorphism and clopidogrel efficacy after percutaneous coronary intervention in Zunyi of Guizhou province

目的 探讨冠心病患者介入治疗后服用氯吡格雷的疗效与CYP2C19 基因多态性的关系.方法 选取2016年1月至2017年12月于贵州航天医院诊断为急性冠脉综合征并接受经皮冠状动脉介入治疗术（PCI）的患者62例,术前行CYP2C19基因型、二磷酸腺苷（ADP）诱导的血小板聚集率和心肌酶学等指标检测,术后24 h行心肌酶学指标复测,根据不同的代谢类型对患者进行分组,比较各组患者以上指标的差异.结果 各基因型所占比例：CYP2C19＊1/＊1为37.10%,CYP2C19＊1/＊2为35.48%,CYP2C19＊1/＊3为11.29%,CYP2C19＊2/＊2为12.90%,CYP2C19＊2/＊3为3.23%,CYP2C19＊3/＊3为0.00%;LDH、AST、CK、CK－MB和α－HBDH在PCI术后均比术前明显升高（t＝0.019、0.040、0.044、0.022、0.014,均P＜0.05）,但快代谢型、中间代谢型和慢代谢型之间的ADP诱导血小板聚集率和心肌酶学等指标差异均无统计学意义（均P＞0.05）.结论 CYP2C19在中国人群中的突变频率较大,该研究的样本量较少,无法得出氯吡格雷抵抗与基因型之间的具体关系,还需要增加样本量并综合多因素考虑.

Objective To investigate the relationship between CYP 2C19 gene polymorphisms and clopidogrel efficacy in coronary heart disease patients after percutaneous coronary intervention （PCI）.Methods From January 2016 to December 2017,62 patients with acute coronary syndromes and treated with PCI in Guizhou Aerospace Hospital were recruited, CYP2C19 genotype, ADP -induced platelet aggregation rate and myocardial enzymes and other indicators were detected before operation .The myocardial enzymes were measured 24 hours after PCI.According to different metabolic types,the patients were grouped,the above indicators were compared.Results The CYP2C19＊1/＊1 was 37.10%,CYP2C19＊1/＊2 was 35.48%,CYP2C19＊1/＊3 was 11.29%,CYP2C19＊2/＊2 was 12.90%,CYP2C19＊2/＊3 was 3.23% and CYP2C19＊3/＊3 was 0.00%.The LDH,AST,CK,CK-MB and α-HBDH in the PCI patients after operation were significantly higher than those before operation （t=0.019,0.040, 0.044,0.022,0.014,all P〈0.05）.But ADP induced platelet aggregation rate and myocardial enzymes and other indicators among fast metabolism group,intermediate metabolic group and slow metabolic group had no statistically significant differences （all P 〉0.05）.Conclusion CYP2C19 mutation frequency in the Chinese population is relatively large,the sample size of this study is less ,the relationship between clopidogrel resistance and the specific genotype can not be obtained ,it need to increase the sample size and comprehensive multi -factor consideration .