CYP2C19代谢型对ACS患者PCI术后氯吡格雷临床应用的疗效分析

Analysis of Clopidogrel Clinical Effects under the Guide of CYP2C19 Metabolism Typing in Patients with ACS after PCI

目的:本研究通过回顾性分析ACS患者CYP2C19酶代谢型对抗血小板聚集药物药效的影响,以期为患者制订PCI术后个体化抗血小板聚集治疗方案提供依据。方法:选择经冠脉造影确诊为急性冠脉综合症、已行PCI术,同时进行了CYP2C19基因多态性检测的患者130例。根据代谢类型不同,将患者分成快、中、慢代谢3组,分析3组患者氯吡格雷及替格瑞洛两种抗血小板药物的使用情况、心血管不良事件发生率、出血不良反应以及院外用药情况。结果:(1)CYP2C19基因检测快代谢型46例,中代谢型62例,慢代谢型22例;(2)在不同代谢型患者中,慢代谢组氯吡格雷的使用率显著低于快代谢组和中代谢组,而替格瑞洛的使用率显著高于快代谢组和中代谢组;(3)在慢代谢组中,使用氯吡格雷的患者心血管缺血事件发生率显著高于替格瑞洛,慢代谢组使用氯吡格雷患者心血管缺血事件发生率显著高于快代谢组和中代谢组;(4)出血不良反应在3组间比较无明显差异;(5)快代谢组质子泵抑制剂的使用率显著高于中、慢代谢组,其余合并用药的使用率在3组间无明显差异。结论:在临床治疗中,检测CYP2C19代谢类型将有助于减少心血管不良事件的发生,使患者获得更大益处。

Objective:To provide a basis for developing individualize anti-platelet therapy for ACS patients after PCI,the impact of CYP2C19 metabolic type on anti-platelet drugs was retrospectively analyzed.Methods:A total of 130 ACS patients diagnosed by coronary angiography and underwent PCI was enrolled,whose CYP2C19 metabolic types were detected.According to the CYP2C19 gene detection,the patients were divided into the fast,intermediate and slow metabolic types.The application of clopidogrel and ticagrelor,incidence of adverse cardiovascular events(ACEs),adverse reactions of bleeding and medication outside the hospital among the 3 groups were compared and analyzed.Results:①The number of patients in fast,intermediate and slow metabolic type groups were 46,62 and 22,respectively.②For patients of the slow metabolic type group,the clopidogrel use rate was significantly lower than those of the other two groups,while the ticagrelor use rate was significantly higher.③In the slow metabolic type group,the incidence of ACEs for clopidogrel-used patients was significantly higher than ticagrelor-used patients,and meanwhile it was also significantly higher than those in the other two metabolic type groups.④No significant difference was found in adverse reactions among the three groups.⑤The use rate of proton pump inhibitors in the fast metabolic group was significantly higher than those in the other two groups,and no difference for other combined drug use rate among the three groups was found.Conclusions:In clinical treatment,CYP2C19 metabolic type was advised to be detected,which can reduce the occurrence of ACEs and make the patients get more benefits.