PCI术后患者CYP2C19基因型检测结果与抗血小板治疗方案的回顾性研究

Retrospective Study of CYP2C19 Genotype and Antiplatelet Therapy in Patients after PCI

目的:探讨氯吡格雷基因检测结果与抗血小板治疗方案的制定结果,为冠心病行PCI术后患者个体化抗血小板治疗提供参考依据。方法:选取2019年1月至2020年8月在国药东风总医院住院期间的冠心病且行PCI术的患者278例作为研究对象,比较基因型分组后各组患者应用不同剂量氯吡格雷、单用替格瑞洛、氯吡格雷转换为替格瑞洛的比例。结果:⑴入选患者CYP2C19*2和CYP2C19*3等位基因分布符合Hardy-Weinberg遗传平衡定律(P>0.05),具有一定的群体代表性;⑵单用氯吡格雷组、单用替格瑞洛组、氯吡格雷转换为替格瑞洛组年龄、性别、糖尿病史等相关临床因素比较,差异均无统计学意义(P>0.05),与吸烟史、高血压史等相关临床因素比较,差异有统计学意义(P<0.05);⑶超快代谢组、快代谢组、中代谢组、慢代谢组的年龄、吸烟史、高血压比较,差异均无统计学意义(P>0.05),与性别、糖尿病史比较,差异有统计学意义(P<0.05);⑷超快代谢型患者中抗血小板方案未见调整;快代谢型中抗血小板方案调整比例为41.5%;中间代谢型中抗血小板方案调整比例为45.5%;慢代谢型患者均选用替格瑞洛作为抗血小板药物。结论:CYP2C19基因检测结果对PCI术后患者的抗血小板方案制定有一定的指导意义。

Objective To investigate the results of clopidogrel gene detection and the formulation of antiplatelet therapy, so as to provide a reference for individualized antiplatelet therapy for patients with coronary atherosclerotic heart disease(CHD) after percutaneous coronary intervention(PCI) treatment. Methods 278 patients with CHD who underwent PCI during their hospitalization at Sinopharm Dongfeng General Hospital from January 2019 to August 2020 were selected as the research objects, and the proportions of patients in each group receiving different doses of clopidogrel, ticagrelor alone and conversion from clopidogrel to ticagrelor were compared. Results ⑴The distribution of CYP2C19;2 and CYP2C19;3 alleles in the selected patients complied with the Hardy-Weinberg genetic balance law(P>0.05), and had a certain population representativeness;⑵There was no significant difference in the age, gender and diabetes history between the clopidogrel group, ticagrelor group and clopidogrel converted to ticagrelor group. The difference was not statistically significant(P>0.05). However, when compared with related clinical factors such as smoking history and hypertension history, the difference was statistically significant(P<0.05);⑶There was no statistically significant difference in age, smoking history, and hypertension in the ultrafast metabolizer group, fast metabolizer group, middle metabolizer group, and slow metabolizer group(P>0.05), but compared with gender and diabetes history, the difference is statistically significant(P<0.05);⑷There was no adjustment in the antiplatelet regimen in patients with ultra-rapid metabolism. The adjustment ratio of antiplatelet regimen in the rapid metabolism type was 41.5%, and the adjustment ratio of the antiplatelet regimen in the intermediate metabolite type was 45.5%. All the slow metabolizer patients chose ticagrelor as an antiplatelet drug. Conclusion The CYP2C19 gene detection results have certain guiding significance for the formulation of antiplatelet regimens for patients after PCI.