CYP2C19基因型检测对急性心肌梗死经皮冠状动脉介入术后抗血小板药物治疗的临床研究

Clinical study of CYP2C19 genotype detection for antiplatelet therapy after PCI in patients with acute myocardial infarction

目的:分析CYP2C19基因型检测用于急性心肌梗死(AMI)经皮冠状动脉介入(PCI)后药物治疗中的价值。方法:前瞻性选取86例AMI患者作为研究对象,随机数字表法分为观察组与对照组。两组入院均行PCI治疗。观察组于术后72 h检测患者CYP2C19基因型分布并指导用药,若基因检测结果显示为氯吡格雷慢代谢或中等代谢型的患者,需停用氯吡格雷,改用替格瑞洛治疗;基因检测结果显示为氯吡格雷快代谢型的患者仍应用氯吡格雷治疗,对照组不检测基因分布行氯吡格雷常规治疗。评估两组治疗3个月后疗效;测定两组治疗前、治疗3个月的心肌标志物水平[肌钙蛋白(cTnI)、肌酸激酶同工酶(CK-MB)],检测两组治疗前、随访结束(治疗12个月)的血小板聚集率,记录患者随期间不良心血管事件(MACE)及出血事件发生情况。结果:治疗3个月,观察组整体疗效优于对照组(P<0.05);观察组cTnI、CK-MB低于对照组(均P<0.05);随访结束,观察组血小板聚集率、MACE、出血事件发生率低于对照组(均P<0.05)。结论:AMI患者经PCI后CYP2C19基因型检测可指导抗血小板用药,提高整体治疗效果,对患者心肌功能、血小板聚集率有良好的影响,能减少不良事件及出血事件的发生。

Objective:To analyze the value of CYP2C19 genotype detection in guiding drug treatment after percutaneous coronary intervention(PCI)in acute myocardial infarction(AMI).Methods:A total of 86 patients with AMI were prospectively selected and divided into observation group and control group by random number table method.Both groups were treated with PCI,and the treatment was carried out routinely according to the guidelines after operation.The CYP2C19 genotype distribution of the patients in the observation group was detected 72 hours after operation and the medication was guided.If the genetic test results showed that the patients were clopidogrel slow metabolism or medium metabolism type,clopidogrel should be discontinued and switched to ticagrelor treatment.The genetic test results showed that the patients with clopidogrel fast metabolism type were still treated with clopidogrel.The control group did not detect gene distribution for clopidogrel routine treatment.The efficacy of the two groups was evaluated after 3 months of treatment.The levels of myocardial markers(cTnI CK-MB)were measured before treatment and 3 months after treatment in the two groups.The platelet aggregation rate of the two groups before treatment and at the end of follow-up(12 months of treatment)was detected,and the adverse cardiovascular events(MACE)and bleeding events were recorded.Results:After 3 months of treatment,the overall effect of observation group was better than that of control group(P<0.05);cTnI and CK-MB in observation group were lower than those in control group(all P<0.05).At the end of follow-up,the platelet aggregation rate,MACE and bleeding event incidence in observation group were lower than those in control group(all P<0.05).Conclusion:The distribution of CYP2C19 genotype in patients with AMI after PCI can guide antiplatelet therapy,which can improve the overall therapeutic effect,have a good effect on myocardial function and platelet aggregation rate,and reduce the occurrence of adverse events and bleeding events.