细胞色素P450酶2C19基因多态性对TIPS术后患者服用氯吡格雷效果的影响

发布时间：2018-03-31 06:00

本文选题：肝硬化　切入点：颈静脉肝内门体分流术　出处：《介入放射学杂志》2017年07期

【摘要】：目的评估细胞色素P450酶2C19(CYP2C19)基因多态性对经颈静脉肝内门体分流术(TIPS)肝硬化患者术后服用氯吡格雷抗血小板治疗的影响。方法收集2013年1月至2014年12月接受TIPS术治疗的171例肝硬化患者临床资料。所有患者均于术中采集门静脉及肘静脉血液样本并行CYP2C19基因检测。术后每3个月临床随访,比较分析基因检测结果与临床随访结果。结果 110例TIPS术前无输血且术后规律服用氯吡格雷患者纳入本研究。术后平均服用氯吡格雷时间为192.4 d(31~517 d),门静脉血及肘静脉血基因检测结果一致,CYP2C19基因型为*1/*1有49例(44.5%)、*1/*2有27例(24.6%)、*1/*3有18例(16.4%)、*2/*2有11例(10.0%)、*2/*3有3例(2.7%)、*3/*3有2例(1.8%);随访显示慢代谢型基因携带患者分流道功能异常发生率为87.5%(14/16),较中等代谢型患者(20.0%,9/45,χ2=22.9,P=0.006)及快代谢型患者(8.2%,4/49,χ2=37.91,P=0.000 1)明显增高;Cox回归模型多变量分析提示CYP2C19慢代谢型基因变异,是分流道功能异常的重要预测因素(95%CI 1.80~9.03,P=0.000 7)。结论 CYP2C19慢代谢基因变异(*2/*2、*2/*3、*3/*3)是影响TIPS术后患者氯吡格雷治疗效果的重要因素之一,术前检测可为术后提供较为有效的抗血小板治疗方案。
[Abstract]:Objective to evaluate the effect of cytochrome P450 enzyme 2C19 (CYP2C19) gene polymorphism on antiplatelet therapy of clopidogrel in patients with liver cirrhosis undergoing intrahepatic portosystemic shunt via jugular vein. Methods from January 2013 to December 2014, TIPS was used to treat patients with liver cirrhosis. The clinical data of 171 patients with liver cirrhosis were collected during operation. Blood samples of portal vein and cubital vein were collected and CYP2C19 gene was detected. Results 110patients without blood transfusion before TIPS and regular clopidogrel after operation were included in this study. The average duration of clopidogrel was 192.4 days after operation, portal vein blood and elbow. There were 49 cases with CYP2C19 genotypes: 44.55.51% of them had 27 cases with 24. 6% of them, 18 cases with CYP2C19 genotype were 16. 440%, 11 cases were in 10. 0% 3, 3 cases were 2. 7% 3, 2 cases were 1. 8%; follow up showed that the incidence of shunt dysfunction in patients with slow metabolic gene was 87.5% 14 / 16%, which was higher than that in patients with slow metabolic type gene carrying the slow metabolic gene (87.5% 16%), which was higher than that of the patients with slow metabolic type gene carrying the slow metabolic type gene (P / P 3), and the incidence of shunt dysfunction was 87.5% 16% in the patients with slow-metabolic gene carrying the gene, and the incidence of shunt dysfunction was 87.5% 16% in the patients with slow metabolic gene. In metabolic type patients, 9 / 45, 蠂 2 + 22. 9% P0. 006) and 8. 2% 4 / 49, 蠂 2 + 37. 91% P0. 000 1) were significantly increased in patients with metabolic type. Multivariate analysis of Cox regression model suggested that CYP2C19 gene mutation in slow metabolic type was significantly increased. It is an important predictor of shunt dysfunction. Conclusion the variation of CYP2C19 slow metabolism gene is 2 / 2 / 2 / 3 / 3 / 3), which is one of the important factors that affect the therapeutic effect of clopidogrel after TIPS. Preoperative detection can provide more effective antiplatelet therapy for postoperative patients.
【作者单位】：贵州医科大学附属医院介入科;
【基金】：贵州省科技计划项目(SY2012-3145)
【分类号】：R575.2

【参考文献】