基因分型指导下的急性冠脉综合征行PCI患者抗血小板治疗的研究

摘要

Objective: To explore antiplatelet therapy curative effects in patients with acute coronary syndrome (ACS) and undergoing percutaneous coronary intervention (PCI) under guidance of cytochrome P450 C19 genotyping (CYP2C19 * 2). Methods: According to CYP2C19 * 2 mutant alleles, a total of 180 ACS patients undergoing PCI were divided into wild-type group carrying CYP2C19 * 2 no- missing function alleles [GG group, n= 92, received routine dual antiplatelet (RDA) therapy], mutant heterozygous group carrying CYP2C19 * 2 missing function alleles (AG group, n = 67, received cilostazol 50 mg, twice a day based on RDA therapy), and mutant homozy-gotes group carrying CYP2C19 * 2 missing function alleles (AA group, n = 21, received cilostazol 100 mg, twice a day based on RDA therapy). Change of platelet aggregation rate was monitored and incidence of major adverse cardiovascular events (MACE) and bleeding event were compared among three groups. Results: Among 180 ACS patients, the wild-type (GG) group AG group and AA group occupied 51. 11%, 37. 22% and 11. 67% respectively. There were no significant differences in clinical data and PCI results among three groups. On 7th and 180th d after administration, platelet aggregation rates of AA group and AG group were significantly lower than that of GG group [180d: (24.3±3.41)%, (25. 8 ± 2. 89)% vs. (30. 3 ± 3. 17)%, P<0. 05]. After 12-month follow-up, there were no significant differences in incidence rates of MACE and bleeding event among three groups. Conclusion: Compared with dual antiplatelet therapy for CYP2C19 * 2 no-missing function alleles (GG type), the platelet aggregation rates significantly decrease, clinical efficacy and safety were no significant difference in triple antiplatelet therapy for CYP2C19 * 2 missing function alleles (AG or AA type) in ACS patients.%目的:探讨细胞色素P450 C19基因(CYP2C19*2)分型指导下急性冠脉综合征(ACS)行PCI患者抗血小板治疗的临床疗效.方法:入选180例行PCI的ACS患者,根据CYP2C19*2等位基因突变情况分为无缺失功能等位基因的野生型组(GG,92例):进行常规双联抗血小板治疗；有缺失功能等位基因的突变杂合型组(AG,67例):在常规双联抗血小板治疗基础上加用西洛他唑50mg,2次/d;突变纯合型组(AA,21例):在常规双联抗血小板治疗基础上加用西洛他唑100mg,2次/d;监测血小板聚集率的变化并比较三组不良心血管事件(MACE)及出血事件的发生情况.结果:ACS患者中的野生型占51.11％,突变杂合型占37.22％、突变纯合型占11.67％.据基因型所分三组临床资料及PCI结果无显著差异.AA组、AG组用药后7d,用药后180d的血小板聚集率均较GG组明显降低[180d:(24.3±3.41)％、(25.8±2.89)％比(30.3±3.17)％,P＜0.05].随访12月,三组的MACE及出血事件发生率无明显差异.结论:三联抗血小板治疗用于CYP2C19*2有缺失功能等位基因(AG或AA)的ACS患者,和双联抗血小板治疗用于CYP2C19*2无缺失功能等位基因的ACS患者比较,血小板聚集率显著降低,但临床效果和安全性相同.CYP2C19*2基因分型可以为个体化抗血小板治疗提供参考.