CYP2C19基因引导的个性化抗血小板治疗在经皮冠状动脉介入术后的应用Meta分析

Individualized anti-platelet therapy under the guidance of CYP2C19 genotype in patients with percutaneous coronary intervention(Meta-analysis)

目的系统评价经皮冠状动脉介入术(PCI)后CYP2C19基因引导的个性化抗血小板疗法与标准氯吡格雷疗法的疗效差异。方法系统检索PubMed、Cochrane Library和Embase平台中已发表的随机对照试验(RCT),分析PCI术后两种治疗方案下全因死亡、心脏死亡、脑卒中、心肌梗死和出血的发生率,使用固定效应模型计算RR及95%CI。结果共入选5项RCT,研究对象7328人,CYP2C19基因引导组3673人,标准治疗组3655人。CYP2C19基因引导组与标准治疗组术后1年内心肌梗死发生率分别为1.74%(64/3673)和3.12%(114/3655)(RR=0.55,95%CI:0.41~0.75,P<0.001);脑卒中、心肌梗死与出血复合发生率为3.96%(144/3639)和5.84%(212/3629)(RR=0.63,95%CI:0.43~0.93,P=0.020);亚洲地区主要心血管不良事件发生率为2.64%(18/682)和6.18%(43/696)(RR=0.43,95%CI:0.25~0.73,P=0.002),差异有统计学意义(P<0.05)。全因死亡率、心脏死亡率、脑卒中发生率、出血发生率比较,差异无统计学意义(P>0.05)。结论CYP2C19基因引导的个性化治疗与标准治疗相比可明显降低PCI术后1年内再发心肌梗死风险,减少脑卒中、心肌梗死和出血的发生。

Objective Systematically evaluating the efficacy difference between the individualized anti-platelet therapy under the guidance of CYP2C19 genotype and standard clopidogrel therapy in patients with percutaneous coronary intervention(PCI).Methods Randomized clinical trials(RCT)published in PubMed,Cochrane Library and Embase databases were searched systematically.The incidence of all-cause death,cardiovascular death,stroke,myocardial infarction and bleeding events in the two treatment regiments after PCI were evaluated by Meta-analysis.Fixed effects model was used to calculate the RR and its 95%CI.Results A total of 5 RCTs were included in Meta-analysis,including 7328 patients,3673 in the CYP2C19 gene guide group and 3655 in the standard treatment group.The incidence of myocardial infarction events in CYP2C19 gene guide group and standard treatment group were 1.74%(64/3673)and 3.12%(114/3655)(RR=0.55,95%CI:0.41-0.75,P<0.001).The incidence of stroke and myocardial infarction as well as bleeding were 3.96%(144/3639)and 5.84%(212/3629)(RR=0.63,95%CI:0.43-0.93,P=0.020).The incidence of major adverse cardiovascular events in Asia were 2.64%(18/682)and 6.18%(43/696),(RR=0.43,95%CI:0.25-0.73,P=0.002).There was no significant difference in the incidence of all-cause mortality,cardiovascular mortality,stroke or bleeding events between two groups(P<0.05).Conclusion Compared with standard therapy,personalized anti-platelet therapy guided by CYP2C19 gene can reduce the incidence of recurrent myocardial infarction in patients after PCI within 1 year,and reduce the occurrence of stroke,myocardial infarction and bleeding.