CYP2C19基因多态性与临床因素对PCI术后氯吡格雷反应性的影响

Effect of CYP2C19 Gene Polymorphism and Clinical Factors on Clopidogrel reactivity Postoperative PCI

目的探讨择期行冠状动脉介入治疗(PCI)患者CYP2C19基因多态性与临床因素对术后氯吡格雷反应性的影响。方法随机选取择期行PCI治疗的急性冠状动脉综合征(ACS)患者478例,采用AGGRAM法测定患者术前及术后1个月的血小板聚集率(ADP),分析患者临床因素(年龄、性别、BMI、LDL-C、eGFR、HbA1c、血压)及基因信息(CYP2C19基因)对ADP变化值的影响。结果患者临床因素均对ADP变化值无显著影响(P均>0.05),CYP2C19基因多态性对ADP变化值有显著影响(P<0.001),与快代谢型(52.30±6.55%)相比,中间代谢型(36.67±7.55%,t=23.211,P<0.001)、慢代谢型(22.06±8.94%,t=22.765,P<0.001)ADP变化值显著降低,差异具有显著性。慢代谢型的ADP变化值也显著低于中间代谢型(t=9.914,P<0.001)。结论ACS择期行PCI术的患者的CYP2C19基因多态性对患者术后1个月的ADP变化具有显著影响,检测CYP2C19基因型对预测患者1个月后ADP变化是具有指导价值的。

Objective To investigate the effects of CYP2C19 gene polymorphism and clinical factors in patients with elective percutaneous coronary intervention(PCI)on clopidogrel reactivity after surgery.Methods 478 patients with acute coronary syndrome(ACS)patients in PCI treatment were randomly selected,and the patient’s preoperative and 1 month of platelet aggregation rate(ADP)were determined by AGGRAM method,effects of clinical factors(age,gender,BMI,LDL-C,eGFR,HbA1c,blood pressure)and genetic information(CYP2C19 gene polymorphism)on ADP change has been analyzed.Results The patient’s clinical factors have no significant effect on the value of the ADP change(P>0.05 for all),however,CYP2C19 gene polymorphism has a significant impact on the value of ADP changes(P<0.001).Compared with Expressive Metabolic(52.30±6.55%),the ADP variation of Intermediate Metabolic(36.67±7.55%,t=23.211,P<0.001)or Poor Metabolites(22.06±8.94%,t=22.765,P<0.001)is significantly reduced,and the difference is significant.Conclusion The CYP2C19 gene polymorphism of ACS patients in PCI has significantly effect on the ADP changes in the 1 month after surgery,and the CYP2C19 genotype has guided significance for the CYP2C19 genotype.Detection of CYP2C19 genotypes for predicting patients 1 month after ADP change is guided.