冠心病患者双抗血小板治疗反应性与CYP2C19基因型的关系

Relationship between responsiveness to dual antiplatelet therapy and CYP2C19 genotypes in patients with coronary heart disease

目的 分析冠心病患者双抗血小板治疗反应性与细胞色素P4502C19(CYP2C19)基因型的关系。方法 选择2021年3月至2023年2月在池州市第二人民医院接受经皮冠脉介入术(PCI)治疗的96例冠心病患者,术后均接受双联抗血小板治疗。根据血小板抑制率将患者分为抗血小板治疗高反应组(n=53)和低反应组(n=43),比较两组CYP2C19基因型、一般资料及血液生化指标,采用Logisic回归分析冠心病患者双抗血小板反应性与CYP2C19基因型的关系。结果 低反应组CYP2C19快代谢型比例低于高反应组,中间代谢型比例高于低反应组,差异有统计学意义(P<0.05)。低反应组总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白(LDL)高于高反应组,差异有统计学意义(P<0.05)。Logistic回归分析结果显示,CYP2C19基因型、高水平LDL是冠心病患者发生抗血小板治疗抵抗的危险因素(P<0.05)。结论 冠心病双抗血小板治疗反应性与CYP2C19基因型关系密切,CYP2C19慢代谢型与高水平LDL是冠心病患者发生双抗血小板治疗抵抗的危险因素,检测CYP2C19基因型或有利于指导冠心病抗血小板治疗。

Objective To analyze the relationship between responsiveness to dual antiplatelet ther⁃apy and cytochrome P4502C19(CYP2C19)genotypes in patients with coronary heart disease.Methods 96 patients with coronary heart disease who underwent percutaneous coronary intervention(PCI)at Chizhou Sec⁃ond People's Hospital from March 2021 to February 2023 were enrolled in this study.All patients received dual antiplatelet therapy after the operation.The patients were divided into a high responsiveness group(n=53)and a low responsiveness group(n=43)based on platelet inhibition rate.CYP2C19 genotypes,general informa⁃tion,and blood biochemical indicators of the two groups were compared.The relationship between responsive⁃ness to dual antiplatelet therapy and CYP2C19 genotypes in patients with coronary heart disease was analyzed.Results The proportion of CYP2C19 fast metabolic types in the low responsiveness group was lower than that in the high responsiveness group,while the proportion of intermediate,and slow metabolic types was higher than in the high responsiveness group(P<0.05).The levels of total cholesterol(TC),triglycerides(TG),and low⁃density lipoprotein(LDL)in the low responsiveness group were higher than those in the high responsiveness group(P<0.05).Logistic regression analysis revealed that CYP2C19 genotypes and high LDL levels were risk factors for resistance to dual antiplatelet therapy in patients with coronary heart disease(P<0.05).Conclusion The responsiveness to dual antiplatelet therapy is closely related to CYP2C19 genotypes in patients with coronary heart disease.CYP2C19 slow metabolic type and high LDL levels are risk factors for resistance to dual antiplatelet therapy in patients.Detecting CYP2C19 genotypes may help guide antiplatelet therapy for coronary heart disease.