急性心肌梗死患者CYP2C19基因多态性分布及氯吡格雷治疗对PCI术后不良心血管事件和再狭窄的影响

The distribution of CYP2C19 gene polymorphism in patients with acute myocardial infarction and the effect of clopidogrel therapy on adverse cardiovascular events and restenosis after PCI

目的:检测急性心肌梗死患者CYP2C19基因多态性分布情况,并分析氯吡格雷治疗对PCI术后不良心血管事件和再狭窄的影响。方法:选取我院2018-01-2019-06期间收治的214例行PCI术的急性心梗患者作为研究对象。所有患者PCI术后均给予阿司匹林和氯吡格雷治疗,采用PCR测定患者全血CYP2C19基因分布,比较患者CYP2C19基因型特征,分析其与发生心血管不良事件及再狭窄的关系。结果:214例患者CYP2C19*1、*2、*3等位基因分布频率分别为66.36%、29.21%及4.43%;快代谢型的频率为44.86%,中代谢型的频率为42.99%,慢代谢型的频率为12.15%。其中,发生心血管不良事件组患者快代谢基因型出现的频率为9.76%,中代谢型基因出现的频率为53.65%,慢代谢基因型出现频率为36.59%(P<0.05);且发生心血管不良事件*1等位基因出现频率为36.59%,显著低于未发生组(P<0.05),而*2等位基因及*3等位基因出现频率分别为51.22%及12.19%,均显著高于未发生组,差异有统计学意义(P<0.05)。单因素分析发现患者再狭窄与氯吡格雷抵抗有关(P<0.05)。结论:急性心梗患者PCI术后发生心血管不良事件患者CYP2C19基因突变率较高,主要以中代谢及慢代谢基因型为主,且患者CYP2C19*2和CYP2C19*3基因突变是导致预后发生不良心血管事件及再狭窄的重要原因。

Objective: To detect the distribution of CYP2 C19 gene polymorphism in patients with acute myocardial infarction and analyze the effect of clopidogrel treatment on adverse cardiovascular events and restenosis after PCI. Method: A total of 214 patients with acute myocardial infarction underwent PCI in our hospital were selected as the study subjects from January 2018 to June 2019. All patients were treated with aspirin and clopidogrel after PCI. PCR was used to determine the distribution of CYP2 C19 gene in the whole blood of the patients. The genotype characteristics of CYP2 C19 of patients were compared, and the relationship between the CYP2 C19 gene and the occurrence of cardiovascular adverse events and restenosis was also analyzed. Result: The distribution frequencies of CYP2 C19*1, *2 and *3 alleles were 66.36%, 29.21% and 4.43%, respectively. The frequency of fast metabolic type was 44.86%, the medium metabolic type was 42.99%, and the slow metabolic type was 12.15%. The frequency of fast metabolic genotypes, medium metabolic genotypes and slow metabolic genotypes in patients with cardiovascular adverse events were 9.76%, 53.65% and 36.59%(P<0.05). Moreover, the occurrence frequency of allele *1 of cardiovascular adverse events was 36.59%, significantly lower than that of allele *1 of the non-occurrence group(P<0.05), and the occurrence frequency of allele *2 and *3 of cardiovascular adverse events were 51.22% and 12.19%, respectively, which significantly higher than that of the non-occurrence group(P<0.05). Single factor analysis found that the restenosis was associated with the clopidogrel resistance(P<0.05). Conclusion: The mutation rate of CYP2 C19 gene in patients with acute myocardial infarction who had cardiovascular adverse events after PCI was high, which the main genotypes were the the middle and slow metabolic genotypes. Meanwhile, the mutation of CYP2 C19*2 and CYP2 C19*3 genes was the important cause of adverse cardiovascular events and restenosis in patients with acute myocardial infarction.