替格瑞洛和西洛他唑对CYP2C19基因变异合并血小板高反应性急性冠脉综合征患者的疗效

The efficacy of ticagrelor and cilostazol in acute coronary syndrome patients with genetic variation of CYP2C19 and platelet hyper-responsiveness

目的观察及评价替格瑞洛或西洛他唑两种方案治疗携带CYP2C19~*2或~*3基因及合并血小板高反应性(HPR)的急性冠脉综合征(ACS)患者的疗效。方法 PCI治疗ACS患者263例,根据CYP2C19~*1、~*2、~*3等位基因及血小板聚集率分组,对照组(179例):快代谢型且不合并HPR,给予阿司匹林100mg/d,氯吡格雷75mg/d;中、慢代谢型且合并HPR者随机分为A、B两亚组,A组(42例)给予阿司匹林100mg/d,替格瑞洛90mg 2次/d;B组(42例)给予阿司匹林100mg/d,氯吡格雷75mg/d,西洛他唑100mg 2次/d。随访24周,检测3组患者血小板聚集率变化及随访主要心血管事件及出血事件。结果 A、B两组血小板聚集率24周后较1周时明显下降,与对照组比较差异无统计学意义(均P>0.05),A、B两组之间差异亦无统计学意义(P>0.05)。随访24周,主要心血管事件及出血事件3组间均无统计学差异(均P>0.05)。结论对携带CYP2C19基因中慢代谢型及合并HPR的ACS患者,替格瑞洛或西洛他唑两种治疗方案均有效,且不增加出血事件。

Objective To evaluate the efficacy of ticagrelor and cilostazol in acute coronary syndrome(ACS)patients carrying CYP2C19*2or*3genes and with platelet hyper-responsiveness(HPR).Methods263ACS patients underwent PCI were enrolled and divided into control group(n=179)with CYP2C19*1and normal platelet responsiveness and group with CYP2C19*2or*3and platelet hyper-responsiveness(HPR).The later group were randomly divided into group A(n=42)and B(n=42).Clopidogrel75mg/d was taken in control group,ticagrelor90mg twice daily in group A,clopidogrel75mg/day with cilostazol100mg twice daily in group B in addition to aspirin100mg per day in all three groups.The changes of platelet aggregation rate and main adverse cardiovascular events(MACE)and bleeding events were detected during follow-up24weeks.Results Platelet aggregation rate was significantly lower at24weeks than at1week in group A and B,and not significantly different from that in control group.There was no significant difference in MACE and bleeding events among three groups.Conclusion The strategies of ticagrelor and cilostazol are effective in the treatment of ACS patients with genetic variation of CYP2C19and HPR and may not increase bleeding events.