CYP2C19基因检测对冠心病患者抗血小板聚集治疗的指导价值

Value of CYP2C19 gene testing in guiding antiplatelet aggregation therapy in patients with coronary heart disease

目的探讨CYP2C19基因型检测对冠心病患者抗血小板聚集治疗的指导价值。方法收集CYP2C19基因检测的住院冠心病患者191例的临床资料,分析CYP2C19基因多态性和不良心血管终点事件发生情况。结果剔除1例超快代谢表型后的190例中,64.74%的患者为功能缺失的等位基因携带者。正常代谢型患者腺苷二磷酸通道抑制率高于慢代谢型[(35.95±27.07)%vs.(21.00±20.19)%](P<0.05)。根据基因检测和血栓弹力图检测结果,54例做了抗血小板聚集治疗方案的调整。随访12个月,调整用药组和未调整用药组(136例)患者不良心血管终点事件发生率无统计学差异(P>0.05)。结论该组冠心病人群中携带CYP2C19功能缺失等位基因比例较高。CYP2C19基因型检测指导抗血小板聚集方案制定的价值有限,不建议作为筛查氯吡格雷疗效的常规检测。

Objective To investigate the value of CYP2C19 gene testing in guiding antiplatelet aggregation therapy in patients with coronary heart disease.Methods The clinical data of 191 inpatients with coronary heart disease were collected,who accepted CYP2C19 gene testing.CYP2C19 genetic polymorphisms and adverse cardiovascular events were analyzed.Results After removing one case with ultrafast metabolic phenotype,123(64.74%)cases of 190 patients were the carriers of loss-of-function allelic gene.Adenosine diphosphate channel inhibition rate of the patients with extensive metabolizer was significantly higher than those with poor metabolizer[(35.95±27.07)%vs.(21.00±20.19)%](P<0.05).Based on genetic tests and thromboelastography,the antiplatelet aggregation therapy was adjusted in 54 cases.The results of follow up for 12 months showed that there were no significant differences in the incidence rates of adverse cardiovascular events between the patients with and without adjustments of antiplatelet aggregation therapy programme(P>0.05).ConclusionThe proportion of the CYP2C19 functional deficit genotypes in this group of patients with coronary heart disease is higher.CYP2C19 genotype testing to guide the formulation of antiplatelet aggregation programme is of limited value and is not recommended as a routine test for screening the efficacy of clopidogrel.