冠心病PCI术后氯吡格雷药效与CYP2C19多态性的关系

Relationship between the efficacy of clopidogrel and CYP2C19 polymorphism after PCI for coronary heart disease

目的探讨冠心病患者经皮冠状动脉介入术(PCI)术后服用氯吡格雷药物反应性和CYP2C19基因多态性之间的关系。方法收集2018年1月至7月确诊为冠心病并进行PCI手术服用氯吡格雷患者231例,根据CYP2C19基因多态性将所有病例分为快代谢组、中间代谢型、慢代谢型三组,通过血栓弹力图检测二磷酸腺苷(ADP)诱导的血小板抑制率(将抑制率<30%定义为氯吡格雷低反应性)和二磷酸腺苷通道血凝块最大强度(MAADP)>47 mm,运用SPSS统计分析三组间抑制率、氯吡格雷低反应性所占比率、MAADP>47 mm所占比率的差异。结果 231例患者快代谢组78例、中间代谢型126例、慢代谢型27例,三组的ADP诱导血小板抑制率分别为(77.04±23.38)%、(75.30±28.67)%、(79.78±28.29)%,无统计学差异(P>0.05);三组氯吡格雷低反应性患者所占比率分别为3.8%、10.3%、7.4%无统计学差异(P>0.05);MAADP>47 mm三组所占比率分别为3.85%、10.32%、3.70%无统计学差异(P>0.05)。结论冠心病PCI术后CYP2C19基因多态性与氯吡格雷药效间并无明显相关性。

Objective To investigate the relationship between the drug responsiveness of clopidogrel and CYP2 C19 gene polymorphism after percutaneous coronary intervention(PCI) in patients with coronary heart disease.Methods A total of 231 patients diagnosed as coronary heart disease and treated with clopidogrel after PCI from January to July 2018 were selected.According to CYP2 C19 gene polymorphism,all cases were divided into fast metabolic type(Group A,n=78),intermediate metabolic type(Group B,n=126) and slow metabolic type(Group C,n=27).The inhibition rate of adenosine diphosphate(ADP)-induced platelets(30% defined as clopidogrel hyporeactivity) and the maximum strength of ADP(MAADP) channel blood clots(47 mm) were detected by thromboelastography.Using SPSS statistical analysis,the differences in inhibition rate,the proportions of clopidogrel hyporeactivity and MAADP were analyzed among three groups.Results ADP-induced platelet inhibition rate were(77.04±23.38)%,(75.30±28.67)%,(79.78±28.29)%respectively in group A,group B and group C,and there were no statistical differences among three groups(P>0.05).There were no statistical differences in the proportion of patients with clopidogrel hyporeactivity(3.8% vs 10.3% vs 7.4%) and the proportion of MAADP47 mm( 3.85% vs 10.32% vs 3.70%) among three groups( all P>0.05).Conclusion There is no significant correlation between CYP2 C19 gene polymorphism and clopidogrel efficacy after PCI for coronary heart disease.