CYP2C19指导高危冠状动脉病变PCI术后抗血小板药物选择研究

发布时间：2019-01-02 20:52

【摘要】：目的:对经皮冠状动脉介入治疗(PCI)的左主干或前降支近端病变患者进行CYP2C19基因多态性检测,判明有无氯吡格雷药物抵抗,指导PCI术后选择合适的抗血小板药物,随访1年,观察主要心血管事件(MACE),明确基因检测指导的治疗作用。方法:2014-01-2016-02武汉市第一医院心内科行PCI术的患者中,选取210例为左主干或前降支近端病变的病例,连续分为CYP2C19基因检测指导治疗组(A组112例,若为氯吡格雷慢代谢,则阿司匹林+替格瑞洛)与常规治疗组(B组98例,阿司匹林+氯吡格雷),分析两组术后3个月及12个月MACE发生情况。结果:A组112例患者中,17例(15.2%)基因检测为氯吡格雷慢代谢型,更换为替格瑞洛治疗。术后3个月时总体MACE发生率A组低于B组(4.5%∶12.2%,P=0.039),A组死亡+非致死性心肌梗死总体发生率低于B组(1.8%∶9.2%,P=0.037);然而非致死性心肌梗死、靶血管再次血运重建两组并无显著性差异。术后12个月时,两组总体MACE发生率比较,差异无统计学意义(7.1%∶14.3%,P=0.092),但A组仍保持较低趋势。结论:接受PCI治疗的冠心病患者,术后进行CYP2C19基因检测,有助于对氯吡格雷慢代谢患者进行针对性替换治疗,从而有效降低这部分患者术后3个月的临床MACE发生率。
[Abstract]:Objective: to detect the polymorphism of CYP2C19 gene in patients with left main or anterior descending branch lesions after percutaneous coronary intervention (PCI), to identify clopidogrel resistance and to guide the selection of appropriate antiplatelet drugs after PCI, and to follow up for 1 year. To observe the therapeutic effect of (MACE), on major cardiovascular events. Methods: among the patients undergoing PCI in Department of Cardiology, first Hospital of Wuhan, 2014-01-2016-02, 210 patients with left main trunk or proximal lesion of anterior descending branch were selected and divided into two groups: group A (group A, 112 cases), and group A (group A, n = 112). For clopidogrel slow metabolism, the incidence of MACE in group B (98 cases, clopidogrel) and routine therapy (group B, 98 cases) was analyzed 3 and 12 months after operation. Results: of 112 patients in group A, 17 (15.2%) showed clopidogrel slow metabolism and were replaced by tigrilol. At 3 months after operation, the overall incidence of MACE in group A was lower than that in group B (4.5: 12.2). The overall incidence of non-fatal myocardial infarction in group A was lower than that in group B (4.5: 12.2), and the overall incidence of non-fatal myocardial infarction in group A was lower than that in group B (1.8: 9.2). However, there was no significant difference between the two groups in non-fatal myocardial infarction and re-revascularization of target blood vessels. At 12 months after operation, there was no significant difference in the incidence of total MACE between the two groups (7.1: 14.3, P 0.092), but the trend of group A was still low. Conclusion: the detection of CYP2C19 gene in patients with coronary heart disease treated with PCI is helpful to the targeted replacement therapy of clopidogrel slow metabolism patients, so as to effectively reduce the incidence of clinical MACE in these patients 3 months after operation.
【作者单位】：武汉市第一医院心血管内科;
【分类号】：R541.4

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