Objective To provide supportive evidence for using Clopidogrel in patients with coronary heart disease(CHD)after percutaneous coronary intervention(PCI). Methods From June 2015 to May 2016,105 cases of CHD were admitted to the Department of Cardiology,the First Affiliated Hospital of Zhengzhou University.Genetic testing for CYP2C19 polymorphisms combined with thromboela-stogram was used to detect the rate of Clopidogrel resistance,and adverse cardiovascular events were recorded for 12 months after PCI.Moreover,multivariate Logistic regression was used to analyze risk factors of Clopidogrel resistance. Results A total of 98 cases completed genetic testing for CYP2C19 polymorphisms.Cases with the wild type allele,heterozygous mutations and homozygous mutations accounted for 35.7%,57.1% and 7.1%,respectively.Compared that for wild type cases(49.6 ± 18.5)%,the platelet inhibition rate was significantly reduced for hybrid mutation cases(38.4 ± 15.2)% and homozygous mutation cases(24.8 ± 12.9)%(t=3.142,3.370;P=0.002,0.001,respectively).Meanwhile,based on pharmacokinetic characteristics,the rates of Clopidogrel resistance for patients with the intermediate metabolic type(the heterozygous mutant type) and the slow metabolic type(the homozygous mutant type)were significantly higher than that for patients with the normal metabolic type(the wild type)(χ2 = 5.687,6.363;P< 0.05,respectively). Follow-up results showed that the incidences of adverse cardiovascular events for wild-type and heterozygous mutation patients were 2.9% and 3.6%,respectively,which were significantly lower than that for homozygous mutant patients(28.6%)(χ2 = 5.815,6.540;P< 0.05,respectively). Multivariate Logistic regression analysis showed that risk factors for clopidogrel resistance were glycosylated hemoglobin Alc level,total cholesterol and white blood cell count. Conclusions Genetic testing for CYP2C19 polymorphisms combined with thromboela-stogram can be used as an effective way to evaluate whether Clopidogrel should be used.It is important to measure the platelet aggregation inhibition rate for early detection of Clopidogrel resistance to insure appropriate drug use.%目的 对经皮冠状动脉介入(PCI)术后患者临床合理应用氯吡格雷提供依据. 方法 收集2015年6月~2016年5月我院心内科诊断为冠心病并行PCI术治疗的105例患者资料.采用CYP2C19基因多态性检测联合血栓弹力图检测患者氯吡格雷抵抗发生情况,并在PCI术后12个月内观察心血管不良事件发生情况.用多因素Logistic回归分析氯吡格雷抵抗发生的相关危险因素. 结果 完成随访患者共98例,发现野生型占35.7%,杂合突变型占57.1%,纯合突变型占7.1%.与野生型(49.6 ± 18.5)% 相比,杂合突变型(38.4 ± 15.2)% 与纯合突变型(24.8 ± 12.9)% 的血小板抑制率降低(t=3.142、3.370,P=0.002、0.001);中间代谢型(杂合突变型)、慢代谢型(纯合突变型)氯吡格雷抵抗发生率高于正常代谢型(野生型)(χ2 =5.687、6.363,P<0.05);随访结果显示,野生型与杂合突变型心血管不良事件发生率分别为2.9%、3.6%,低于纯合突变型发生率28.6%(χ2 =5.815、6.540,P<0.05);Logistic回归分析发现,氯吡格雷抵抗的相关危险因素有糖化血红蛋白 A1c、总胆固醇、白细胞计数. 结论 CYP2C19基因多态性检测与血栓弹力图检测可作为评价氯吡格雷临床合理用药的有效办法.应加强血小板聚集抑制率的检测,早期发现氯吡格雷抵抗,为临床合理用药提供保障.
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