冠心病合并高血压患者CYP2C19基因多态性与氯吡格雷抵抗的研究

Study on CYP2C19 gene polymorphism and clopidogrel resistance in patients with coronary heart disease complicated with hypertension

目的研究冠心病合并高血压患者CYP2C19基因多态性及不同基因型与氯吡格雷抵抗(CR)的关系。方法纳入确诊冠心病患者104例,分为合并高血压组及不合并高血压组,入院治疗上均予以氯吡格雷75 mg联合阿司匹林100 mg抗血小板治疗,留取患者静脉血标本,通过基因芯片法测定CYP2C19基因型,检测入院后次日以及服药5 d血小板聚集率,观察合并高血压组及不合并高血压CYP2C19不同基因型分布及两组氯吡格雷抵抗情况。结果冠心病合并高血压与不合并高血压患者相比,氯吡格雷CYP2C19代谢基因型在两组中分布差异无统计学意义(P=0.135),且两组CR的发生率差异无统计学意义。对CYP2C19基因多态性进行分组,结果发现慢代谢型组及中等代谢型组较快代谢型氯吡格雷抵抗的发生率增高(P<0.05),且慢代谢发生CR率显著增高。冠心病合并高血压患者logistic多元回归分析提示CYP2C19基因是CR发生的独立预测因子。结论冠心病患者CYP2C19基因多态性及CR发生率与是否合并高血压无关,但CR和CYP2C19基因多态性显著相关。

Objective To study the distribution of CYP2C19 gene polymorphism and the relationship between different genotypes and clopidogrel resistance(CR)in patients with coronary heart disease and hypertension.Methods One hundred and four patients with coronary heart disease were divided into two groups:hypertension group and non-hypertension group.All patients were treated with clopidogrel 75mg and aspirin 100mg antiplatelet therapy.CYP2C19 genotype was detected by by gene chip method,and the platelet aggregation rate were detected on the next day and 5 days after take medicine.The distribution of different genotypes of CYP2C19 and the clopidogrel resistance were observed.Results There was no significant difference in the metabolic genotype of CYP2C19 between the two groups(P=0.135),and there was no significant differences between the two groups in the incidence of CR.The incidence of CR was increased in the slow and middle metabolizing group(P<0.05),and the incidence of CR was significantly increased.Logistic multivariate regression analysis showed that the CYP2C19 gene was an independent predictor of CR in patients with coronary heart disease and hypertension.Conclusions The polymorphisms of CYP2C19 gene and the incidence of CR in patients with coronary heart disease are not associated with hypertension,but CR and CYP2C19 gene polymorphisms are significantly correlated.