CYP2C19基因多态性与氯吡格雷抵抗的相关性

Correlation Between CYP2C19 Gene Polymorphism and Clopidogrel Resistance

氯吡格雷是急性冠脉综合征及经皮冠状动脉介入治疗术前、术后抗血小板治疗方案中最常用的药物,对于患者能否从中远期获益有非常重要的作用。然而近年来,随着氯吡格雷的应用,发现其对血小板的抑制存在明显的个体差异,导致部分患者不能从中获益,即存在氯吡格雷抵抗现象(CR)。CR受多方面因素的影响,而CYP2C19基因多态性是最重要的内部因素。因此,准确识别不同患者之间的基因多态性,认识CR,制定个体化抗血小板治疗方案,对于其预后尤为重要。本文将从氯吡格雷的作用机制及其代谢特点、CYP2C19基因多态性与氯吡格雷抵抗相关性、基因检测的临床应用等方面作一综述。

Clopidogrel is the most commonly used drug in acute coronary syndrome and percutaneous coronary intervention before and after antiplatelet therapy.It has a very important role in whether patients can benefit from the medium and long term.However,in recent years,with the application of clopidogrel,it has been found that there are obvious individual differences in the inhibition of platelets,resulting in some patients unable to benefit from it,that is,clopidogrel resistance(CR).CR is affected by many factors,and CYP2 C19 gene polymorphism is the most important internal factor.Therefore,it is particularly important for the prognosis to accurately identify genetic polymorphisms among different patients,recognize CR,and formulate individualized antiplatelet treatment programs.This article will review the mechanism of action and metabolic characteristics of clopidogrel,the correlation between CYP2 C19 gene polymorphism and clopidogrel resistance,and the clinical application of genetic testing.