氯吡格雷与替格瑞洛对维吾尔族ACS患者不同CYP2C19基因代谢型血小板抑制率的比较

Effects of clopidogrel and ticagrelor on the platelet inhibition rate of different CYP2C19 gene metabolizing type in Uygur ACS

目的比较氯吡格雷与替格瑞洛对维吾尔族急性冠脉综合征(ACS)患者不同CYP2C19基因代谢型血小板抑制率的影响。方法选取2018年1-8月喀什地区第二人民医院收治的维吾尔族ACS住院患者120例为研究对象,根据治疗方法不同分为观察组(62例)和对照组(58例)。对照组采用阿司匹林100 mg/d联合氯吡格雷75 mg/d治疗;观察组给予阿司匹林100 mg/d联合替格瑞洛90 mg每天2次治疗,2组患者均采用PCR-RFLP法测定CYP2C19基因分型,观察2组12个月后不良心血管事件随访结果,2组用药后ACS患者血小板抑制率,比较2组不同CYP2C19基因多态性分型治疗后ACS患者血小板抑制率及不良心血管事件。结果观察组总心血管事件发生率低于对照组(P<0.05),但主要出血事件及次要出血事件在2组间无统计学差异(P>0.05),最小出血事件在观察组中发生率较高,但与对照组比较无统计学差异(P>0.05);2组不同CYP2C19基因多态性治疗前均无统计学意义(P>0.05),治疗1、6、12个月后观察组不同CYP2C19基因多态性血小板抑制率升高(P<0.01),且观察组不同CYP2C19基因多态性血小板抑制率明显高于对照组(P<0.01);2组3种代谢分型总心血管事件发生率差异无统计学意义(P>0.05)。最小出血在中代谢型组、慢代谢型组发生率较高,但差异无统计学意义(P>0.05)。结论ACS患者使用替格瑞洛抗血小板聚集的疗效不受CYP2C19基因多态性的影响。

Objective To investigate the effects of clopidogrel and ticagrelor on the platelet inhibition rate of different CYP2C19 gene metabolizing type in Uygur ACS.Methods A total of 120 Uygur ACS hospitalized patients admitted in Kashgar Perfecture Second People's Hospital between January to August 2018 were randomly divided into the control group(58 cases,spirin 100 mg/d combined with clopidogrel 75 mg/d)and the treatment group(62 cases).The treatment group was treated with aspirin 100 mg/d combined with tigrelo 90 mg twice a day.The CYP2C19 genotype was determined by PCR-RFLP method in both groups.The follow-up results of adverse cardiovascular events after 12 months were observed.The platelet inhibition rates of ACS patients in the two groups were compared after treatment with different CYP2C19 genotyping.Platelet inhibition rate and adverse cardiovascular events.Results The incidence of total cardiovascular events in the treatment group was significantly lower than that in the control group(P<0.05),but there was no significant difference between the two groups in inducing major and minor bleeding(P>0.05).The two groups of different CYP2C19 gene polymorphisms were not statistically significant before treatment.After 1 month,6 months,and 12 months of treatment,the platelet inhibition rate of different CYP2C19 gene polymorphisms in the treatment group increased(P<0.05);and treatment The platelet inhibition rate of CYP2C19 gene polymorphism in different groups was significantly higher than that in the control group(P<0.01);the incidence of total cardiovascular events of the three metabolic types in the two groups was significantly higher than that in the control group(P<0.01).There was no significant difference(P>0.05).The incidence of minimal hemorrhage was higher in the middle metabolic group and the slow metabolic group,but there was no significant difference(P>0.05).Conclusion The efficacy of ticagrelor in anti-platelet aggregation in patients with Uygur ACS is not affected by CYP2C19 gene polymorphism.