基因检测在急性冠脉综合征患者PCI术后个体化抗血小板治疗中的应用

发布时间：2018-03-17 18:14

本文选题：氯吡格雷　切入点：急性冠脉综合征　出处：《中国药房》2017年23期 　论文类型：期刊论文

【摘要】：目的:探讨基因检测在急性冠脉综合征(ACS)患者经皮冠状动脉介入治疗(PCI)术后氯吡格雷个体化抗血小板治疗中的应用价值。方法:临床药师参与3例ACS患者PCI术后抗血小板治疗,综合分析其病变复杂程度、支架长度及数量、并发症、吸烟史等发生支架内血栓的危险因素,建议行氯吡格雷相关基因[细胞色素P450(CYP)2C19、对氧磷酶1(PON1)、三磷酸腺苷结合盒亚家族B成员1(ACBC1)等]检测,并根据检测结果分别提出更换其他类别的抗血小板药、维持原治疗方案并增加监测强度等建议。结果:医师采纳临床药师建议。综合基因检测结果及患者临床因素优化抗血小板治疗方案后,3例患者病情稳定,均带药出院。结论:基因检测可为ACS患者PCI术后个体化抗血小板治疗方案的制订提供依据,可作为临床药师开展药学服务的切入点之一。临床药师在进行基因检测时,应对ACS患者进行血栓风险评估,选择适宜的检测人群;同时应在基因检测的基础上,综合评估患者的用药依从性、支架内血栓风险、药物疗效及不良反应等临床因素和循证药学证据,优化抗血小板治疗方案,以保证用药的安全、有效。
[Abstract]:Objective: to evaluate the value of gene detection in the individual antiplatelet therapy of clopidogrel after percutaneous coronary intervention (PCI) in patients with acute coronary syndrome (ACS). Methods: clinical pharmacists participated in antiplatelet therapy after PCI in 3 patients with ACS. The complications, length and quantity of stent, complications, smoking history and other risk factors of stent thrombosis were analyzed. It is suggested that clopidogrel related genes [cytochrome P450, CYPf2C19, paraoxonase 1PPON1, adenosine triphosphate binding box subfamily B member 1ACBC1] be detected, and other antiplatelet drugs were proposed according to the results. Results: doctors accepted the advice of clinical pharmacists. Comprehensive gene test results and patients' clinical factors optimized antiplatelet therapy regimen after 3 patients were in stable condition. Conclusion: gene detection can provide basis for the formulation of individualized antiplatelet therapy after PCI in patients with ACS, and can be used as one of the cut-in points for pharmacists to carry out pharmaceutical care. The patients with ACS should be evaluated for thrombus risk, and the appropriate population should be selected. At the same time, the compliance of drug use and the risk of thrombus in stent should be comprehensively evaluated on the basis of gene test. In order to ensure the safety and effectiveness of antiplatelet therapy, clinical factors such as drug efficacy and adverse reactions and evidence-based pharmacological evidence were used to optimize antiplatelet therapy.
【作者单位】：咸宁市中心医院/湖北科技学院附属第一医院药剂科;南方医科大学南方医院药学部;
【分类号】：R541.4

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