替格瑞洛改善CYP2C19*2、*3基因ACS PCI术后患者的临床疗效观察

摘要

目的:对于携带CYP2C19*2、*3等位基因者,观察替格瑞洛对急性冠脉综合征PCI术后心脑血管事件的预后影响.方法:CYP2C19基因检测盒检测CYP2C19基因缺陷携带者共809例(CYP2C19*1/*2、CYP2C19*1/*3、CYP2C19*2/*2、CYP2C19*2/*3、CYP2C19*3/*3),符合入选条件和排除条件共有152例,根据术后服用药物分为氯吡格雷组和替格瑞洛组,分析一般临床资料、既往病史、生化指标(HbA1C、LVEF、TC、LDL-c、TG)、服药情况和冠脉造影情况.结果:携带CYP2C19*2、*3等位基因患者,替格瑞洛能够明显改善急性冠脉综合征PCI术后12月再发心绞痛和总MACCE事件(P<0.05),但在术后1、3、6及12月再发心肌梗死、心源性休克、心源性死亡、全因性死亡及脑卒中等,无统计学差异(P>0.05).两者在PCI术后1、3、6及12月并没有增加出血的风险(P>0.05).于氯吡格雷或替格瑞洛能够降低携带CYP2C19*2、*3等位基因患者冠脉再次血运重建、支架内再狭窄及支架内血栓的发生率,但两者无统计学差异(P>0.05).结论:携带CYP2C19*2、*3任一缺陷基因,替格瑞洛都比氯吡格雷明显降低ACS PCI术后12月再发心绞痛和总MACCE事件,且不增加出血的风险;替格瑞洛比氯吡格雷能够降低冠脉再次血运重建、支架内再狭窄和支架内血栓的发生率,但无统计学差异.%Aim:In the patients carrying CYP2C19*2、*3 alleles,clinical efficacy of ticagrelor was observed to study whether the drug can improve acute coronary syndromes and the cardiovascular prognosis after PCI.Methods: 152 hospitalized ACS patients with complete clinic information were detected for CYP2C19 gene defects, including CYP2C19*1/*2、CYP2C19*1/*3、CYP2C19*2/*2、CYP2C19*2/*3、CYP2C19*3/*3.All patients met the inclusion criteria and exclusion conditions.According to the postoperation drugs selected, the patients were divided into group clopidogrel and group ticagrelor.The clinical data,history,biochemical indexes(HbA1C,LVEF,TC, LDL-c and TG),medication,and coronary angiography were analyzed.Results:1.For the carriers of CYP2C19*2,*3 alleles, ticagrelor was found to obviously improve recurrent angina and total MACCE events in about12 months after ACS and PCI(P<0.05),but in the postoperative first,third,sixth and twelfth months, differences in myocardial infarction, cardiogenic shock, cardiac death, all -cause mortality and stroke were not found statistically significant(P>0.05).In the 1th,3th,6th and 12th months after PCI,both groups didn't increase the risk of bleeding(P>0.05).2.Both clopidogrel and ticagrelor reduced the incidences of blood supply reconstruction,stent restenosis and stent thrombosis in CYP2C19*2,*3 allele carriers, but no statistical difference was observed(P>0.05).Conclusion:For the patients carrying any of CYP2C19*2,*3 defective genes,ticagrelor treatment could significantly reduce the recurrent angina and total MACCE events for about 12 months after PCI without increase of the risk of bleeding.At the same time, ticagrelor decreased coronary revascularization, stent restosis, and stent thrombosis,but no statistical difference was observed when it is compared to clopidogrel.