CPY2C19基因多态性对氯吡格雷预防血液透析患者内瘘血栓疗效的影响

目的 探讨CYP2C19基因多态性对氯吡格雷预防血液透析患者内瘘血栓疗效的影响.方法 选取 2015年11月至2018年4月血液透析初次造瘘患者347例,所有患者均给予氯吡格雷进行预防内瘘血栓治疗6个月,根据 CYP2C19基因型分析结果,观察快代谢组(n=101)、中间代谢组(n=192)和慢代谢组(n=54)服药前及服药后5d血小板聚集抑制率及治疗期内内瘘血栓发生率,并进行比较分析.结果 各组服药后5d血小板聚集抑制率均较服药前显著降低(P<0.05),其中快代谢组服药后14 d 血小板聚集抑制率显著低于中间代谢组和慢代谢组(P<0.05),氯吡格雷抵抗发生率分别为5.94%、15.63%及37.04%.治疗期内快代谢组、中代谢组和慢代谢组初次内瘘血栓发生率分别为7.92%、17.19%和42.59%,三组差异有统计学意义(P<0.05).结论 CYP2C19 等位基因 *2 和/(或)*3与氯吡格雷抵抗关系密切,会明显影响氯吡格雷对血液透析患者内瘘血栓的预防效果,建议临床医师根据CYP2C19基因检测结果,进行氯吡格雷个体化用药.

Objective To investigate the effect of CPY2C19 gene polymorphism on clopidogrel in preventing internal fistula thrombosis in hemodialysis patients.Methods From November 2015 to April 2018 in our hospital,347 cases of patients with hemodialysis having 6 months of clopidogrel treatment were chosen and according to the genotype analysis of CYP2C19,the inhibition rate of platelet aggregation before treatment and after 5 days and the incidence of internal fistula thrombosis in treatment during of fast metabolic group(n=101),middle metabolic group(n=192)and slow metabolic group(n=54)were observed and compared.Results 14 days after taking medicine,the inhibition rates of platelet aggregation in all groups were significantly lower than that before the treatment(P<0.05),which in the fast metabolism group was lower than that in the middle metabolism group and the slow metabolism group(P<0.05).The incidences of clopidogrel resistance were 5.94%(6/101),15.63%(30/192)and 37.04%(20/54)respectively.The incidences of primary internal fistula thrombosis were 6.52%(8/101),17.19%(33/192)and 42.59%(23/54)in fast metabolic group,middle metabolic group and slow metabolic group during the treatment period,respectively,with statistical significance(P<0.05).Conclusion CYP2C19 allele*2 and/(or)*3 are related to clopidogrel resistance,which can significantly affect the prevention effect of clopidogrel on internal fistula thrombosis in hemodialysis patients.Clinicians are advised to use individual treatment program from according to the results of CYP2C19 gene detection.