细胞色素CYP 2C19*2基因多态性对冠心病氯吡格雷服用者预后影响的Meta分析

摘要

目的：系统评价细胞色素CYP2C19*2基因多态性对服用氯吡格雷的冠心病患者的临床预后影响。方法通过检索Pubmed、EMBASE、Scopus、Cochrane图书馆、中国生物医学文献数据库（SinoMed）、万方数字化期刊全文数据库中公开发表的相关文献，由2名研究者独立筛选和评价，利用RevMan5．1软件进行统计学分析。结果参考16篇文献，共计14674例受试者。与CYP2C19*2基因非携带者相比，携带者发生不良心血管事件（OR＝1．58，95％CI：1．19～2．10）、支架内血栓形成（OR＝2．92，95％CI：2．10～4．08）、心肌梗死（OR＝1．62，95％CI：1．35～1．95）、脑卒中（OR＝2．12，95％CI：1．34～3．36）的风险较高（P＜0．01），再次接受血运重建术的比例较高（OR＝1．27，95％CI：1．03～1．57，P＜0．01）；二者出现死亡或出血的发生率差异无统计学意义（P＞0．05）。结论 CYP2C19*2基因多态性与服用氯吡格雷的冠心病患者的临床预后相关，CYP2C19*2基因携带者患心血管疾病的风险更高。%Objective To evaluate the impact of cytochrome CYP2C1 9*2 polymorphism on clinical prognosis of coronary artery disease patients treated with clopidogrel.Methods Articles reporting the association between CYP2C1 9*2 polymorphism and clin-ical prognosis in clopidogrel-treated patients were selected from Pubmed,EMBASE,Scopus,Cochrane Library,SinoMed and Wan Fang Digital Journal Database.Literature review and data extraction were completed by two investigators independently.All statisti-cal tests were performed with RevMan5.1.Results Sixteen researches with 14 674 participants were included.CYP2C19*2 carri-ers presented an increased risk of adverse cardiovascular events(OR=2.92,95%CI:2.10-4.08),myocardial infarction(OR=1.62,95%CI:1.35-1.95),stroke(OR=2.12,95%CI:1.34-3.36,P<0.01)and revascularization(OR=1.27,95%CI:1.03-1.57,P<0.01)than non-carriers.No significant differences were found in mortality and risk of bleeding between the two groups(P>0.05).Conclusion CYP2C19*2 polymorphism is associated with the clinical prognosis of coronary artery disease patients trea-ted with clopidogrel.CYP2C1 9*2 carriers have an increased risk of adverse cardiovascular events.