CYP2C19基因代谢型对冠心病患者PCI术后抗血小板药物疗效的影响

Efficacy of CYP2C19 gene metabolic types on antiplatelet drugs in patients with CHD after PCI

目的回顾性分析冠心病患者行经皮冠状动脉介入(PCI)术后CYP2C19基因代谢型对氯吡格雷和替格瑞洛临床疗效的影响,为临床开展个体化用药治疗提供参考。方法选择2017年1月~2018年9月潍坊市人民医院心内科行PCI术和CYP2C19基因检测的冠心病患者94例,根据CYP2C19基因型将患者分为快代谢型、中代谢型和慢代谢型3型,统计分析3型患者氯吡格雷、替格瑞洛使用情况和1年内不良终点事件发生情况。结果 CYP2C19基因快代谢型占41.49%,中代谢型占47.87%,慢代谢型占10.64%;快代谢型和慢代谢型患者抗血小板药物以氯吡格雷为主,中代谢型患者使用替格瑞洛居多;快代谢型使用氯吡格雷患者缺血性事件发生率显著低于替格瑞洛(χ~2=4.848,P=0.028),中代谢型明显高于替格瑞洛(χ~2=5.511,P=0.019);快代谢型使用替格瑞洛患者缺血性事件发生率明显高于中代谢型和慢代谢型(χ~2=7.516,P=0.006;χ~2=4.800,P=0.028);3型患者出血性事件发生率在两种抗血小板药物间均无明显差异(χ~2=0.264,P=0.607;χ~2=3.291,P=0.070)。结论 CYP2C19基因快代谢型患者可优先选择氯吡格雷抗凝治疗,中代谢型和慢代谢型患者使用替格瑞洛获益更大。

Objective To retrospective analyze the impact of CYP2 C19 gene metabolic type on the clinical efficacy of clopidogrel and ticagrelor in patients with coronary heart disease(CHD) after PCI from Weifang Han population,and provide reference for clinical individualized medication.Methods A total of 94 CHD patients with PCI was chosen from Cardiology Department of Weifang People’s Hospital from Jan.2017 to Sep.2018,whose CYP2 C19 gene metabolic types were detected.According to the CYP2 C19 gene detection,the patients were divided into three types:the fast metabolic type,intermediate metabolic type and slow metabolic type.The rate of clopidogrel and ticagrelor utilization was compared,and the occurrence of adverse end-point events was observed during one year of antiplatelet drugs therapy in three metabolic groups.Results The fast metabolic type of CYP2 C19 gene accounted for 41.49%,the intermediate type accounted for 47.87%,and the slow type accounted for 10.64%.Clopidogrel was the main antiplatelet drug in patients with fast metabolic type and slow metabolic type,while ticagrelor was most commonly used in patients with intermediate metabolic type.The incidence of ischemic adverse events in patients treated with clopidogrel was significantly lower than that treated with ticagrelor in the fast metabolic type(χ~2=4.848,P=0.028),and significantly higher than ticagrelor in the intermediate metabolic type(χ~2=5.511,P=0.019).The incidence of ischemic adverse events in patients used ticagrelor in the fast metabolic type was significantly higher than those in the intermediate and slow metabolic type(χ~2=7.516,P=0.006;χ~2=4.800,P=0.028).As for the occurrence rate of hemorrhagic,no statistical difference was found among the three metabolism type between the two antiplatelet drugs(χ~2=0.264,P=0.607;χ~2=3.291,P=0.070).Conclusion Under the guidance of CYP2 C19 genotype,clopidogrel can be preferred to use for patients with fast metabolic type,and patients with metabotropic and slow metabolic type will benefit more from ticagrelor.