基于CYP2C19基因型分组对冠状动脉支架置入术后患者短期内抗血小板治疗的有效性和安全性研究

摘要

Objective The objective of this study is to compare the short term clinical efficacy and safety of antiplatelet therapy according to CYP2C19 phenotype in patients after percutaneous coronary intervention (PCI).Methods 204 patients with coronary heart disease who received PCI were enrolled in our study from Jul 2014 to Nov 2014.Based on the number of the CYP2C19 mutation allele,patients were divided into extensive metabolizers group (CYP2C19 * 1 /* 1),intermediate metabolizers group ( CYP2C19 * 1 /*2、CYP2C19 * 1 /* 3) and poor metabolizers group ( CYP2C19 * 2 /* 2、CYP2C19 * 2 /* 3、CYP2C19*3/*3) .All rolled patients were treated with dual antiplatelet therapy with aspirin and clopidogrel/ Ticagrelor.The primary end point of the study were the incidence of major cardiovascular events (including death, stent thrombosis, stent restenosis, nonfatal myocardial infarction, target vessel revascularization),The adverse clinical events were minor bleeding, allergies, breathing difficulties. Comparison the clinical outcomes 30 d after the procedure.Results The primary end point in poor metabolizers is higher than intermediate metabolizers(HR=1.026P=0.01) and extensive metabolizers(HR=1.036P=0.02), The adverse clinical events were no statistical differences.Conclusions It is useful to predict cardiac ischemic events according to CYP2C19 genotype after percutaneous coronary intervention,Using 150mg clopidogrel or ticagrelor for antiplatelet in patients with coronary artery stenting in clopidogrel resistance cases is safe and effective.%目的：评价基于CYP2C19基因型分组方式，对冠状动脉支架置入术后抗血小板药物的患者短期临床预后及安全性的评价。方法：连续入选2014年6月至2014年11月我院住院、接受冠状动脉造影检查并至少置入一枚支架的患者，术后行CYP2C19基因检测，根据CPY2C19基因检测结果分为不同的代谢型组（快代谢型、中间代谢型、慢代谢型）。分别接受阿司匹林100mg／d+氯吡格雷75mg／d、阿司匹林100mg/d+氯比格雷150mg/d或者阿司匹林100m/+替格瑞洛双联抗血小板治疗。主要观察主要心脏事件（心脏性死亡、急性心肌梗死、支架内血栓、以及预期外的支架植入血管再次血运重建）和不良事件（包括轻微出血、过敏、呼吸困难）。比较根据基因型分组后患者，上述事件的发生率是否存在组间差异。结果：204例接受了冠脉支架植入患者中，主要心脏事件在慢代谢组患者中依次高于中间代谢型（HR=1.026 P=0.01）和快代谢型患者（HR=1.036 P=0.02），不良事件的发生率无组间显著差异（P均＞0.05）。结论：CYP2C19基因型检测结果指导下的ADP受体拮抗剂的选择对术后心脏缺血性事件的预测有意义，在CYP2C19位点基因突变的患者中波立维150mg以及新型抗血小板药物替格瑞洛短期内安全有效。