双联抗血小板治疗对不同CYP2C19基因型冠心病PCI术后伴血脂异常患者抗血小板效果研究

Antiplatelet effect of dual antiplatelet therapy on patients of different CYP2C19 genotypes with coronary heart disease and dyslipidemia after PCI

目的观察不同细胞色素P4502C19(CYP2C19)基因型的冠心病经皮冠状动脉介入(PCI)术后伴血脂异常患者双联抗血小板治疗效果。方法选取2018年8月2021年3月该院收治的行PCI术并进行标准双联抗血小板治疗的冠心病患者199例,根据低密度脂蛋白胆固醇(LDL-C)水平分为高LDL-C组(94例)和血脂正常组(105例)。比较两组患者血小板计数、血栓弹力图普通杯血栓最大振幅(MA值)及不同CYP2C19基因型患者二磷酸腺苷(ADP)诱导的血小板聚集抑制率。结果血脂正常组、高LDL-C组血小板计数、MA值差异无统计学意义(P>0.05);血脂正常组、高LDL-C组快代谢型(EM)基因型患者血小板聚集抑制率均明显高于中间代谢型(IM)、慢代谢型(PM)基因型(P<0.05),IM基因型高于PM基因型(P<0.05);高LDL-C组EM、IM基因型患者血小板聚集抑制率低于血脂正常组(P<0.05),PM基因型血小板抑制率稍低于血脂正常组,但差异无统计学意义(P>0.05)。结论冠心病PCI术后伴血脂异常患者经标准双联抗血小板治疗后,CYP2C19基因EM、IM、PM基因型血小板聚集抑制率依次减弱,LDL-C水平会影响血小板抑制率,提示改善患者血脂水平和按照EM、IM、PM基因型调整药物对临床抗血小板治疗有一定效果。

Objective To investigate the antiplatelet effect of dual antiplatelet therapy on patients of different CYP2C19 genotypes with coronary heart disease and dyslipidemia after percutaneous coronary intervention(PCI).Methods A total of 199 patients with coronary heart disease who underwent PCI and standard dual antiplatelet therapy in the hospital from August 2018 to March 2021 were selected.According to the level of low density lipoprotein cholesterol(LDL-C),they were divided into high LDL-C group(94 cases)and normal lipid group(105 cases).Platelet count,the maximum amplitude of normal cup thrombus(MA)in Thromboelastogram and the inhibition rate of platelet aggregation induced by adenosine diphosphate(ADP)in patients with different CYP2C19 genotypes were compared between the two groups.Results There was no significant difference in platelet count and MA between the two groups(P>0.05).In each group of normal lipid and high LDL groups,platelet aggregation inhibition rate of EM type was significantly higher than those of IM and PM genotype(P<0.05),and IM genotype was higher than that of PM genotype(P<0.05).Meanwhile,the platelet aggregation inhibition rates of EM and IM genotypes in high LDL-C group were lower than those in normal lipid group(P<0.05),and the platelet aggregation inhibition rate of PM genotypes was slightly lower than that in normal lipid group,but the differences were not statistically significant(P>0.05).Conclusion In patients with coronary heart disease and dyslipidemia after PCI,the platelet aggregation inhibition rates of EM,IM and PM genotypes of CYP2C19 gene decrease successively after standard dual antiplatelet therapy,and LDL-C level may affect platelet inhibition rate.It is suggested that improving blood lipid level and adjusting drugs according to EM,IM and PM genotypes have certain effect on clinical antiplatelet therapy.