PCI术后患者CYP2C19基因多态性与氯吡格雷抵抗关联性研究

摘要

Objective: To explore the relationship between clopidogrel resistance and CYP2C19 gene polymorphisms. Methods:A total of 444 cases diagnosed as acute coronary syndrome (ACS) and treated with PCI were retrospectively selected from March 2006 to April 2015. The platelet aggregation rate induced by ADP more than 46% was defined as the clopidogrel resistance, and platelet aggregation rate of 46% or less was defined as sensitive to clopidogrel. Comparison of genotype differences between two groups and risk of clopidogrel resistance among different genotypes were analyzed.Results:CYP2C19*2 or *3 heterozygote mutations in ACS patients were associated with a significant increase the risk of clopidogrel resistance compared with CYP2C19*1/*1. CYP2C19*2/*2 and *2/*3 were at higher risk of clopidogrel resistance. Platelet aggregation rates of *1/*2、*2/*2 and *2/*3 were significantly higher than that of *1/*1 genotype.Conclusion: CYP2C19*2 or *3 mutations were associated with clopidogrel resistance in ACS patients. The rate of platelet aggregation increased with the increase of the number of mutant gene loci of CYP2C19*2 and *3.%目的：探讨PCI术后患者CYP2C19基因多态性与氯吡格雷抵抗的关联性。方法：回顾性筛选2006年3月–2015年4月444例诊断为急性冠脉综合征（ACS）并进行PCI治疗的患者，以ADP诱导的血小板聚集率>46%定义为氯吡格雷抵抗，血小板聚集率≤46%定义为氯吡格雷敏感，分析两组之间基因型的差异，并比较不同基因型发生氯吡格雷抵抗的危险度。结果：CYP2C19*2、*3突变杂合子的氯吡格雷抵抗风险显著高于野生型*1/*1。两组患者中CYP2C19*2/*2、*2/*3发生氯吡格雷抵抗的风险更高。相对于*1/*1基因型，*1/*2、*2/*2和*2/*3具有更高的血小板聚集率。结论：急性冠脉综合征患者CYP2C19*2、*3突变与氯吡格雷抵抗相关，随着CYP2C19*2、*3的突变基因位点数量增加血小板聚集率也逐渐增加。