CYP2C19基因多态性检测指导急性冠脉综合征患者PCI术后抗血小板精准治疗的临床研究

刘鹃锋 何伟喜 刘志辉

[摘要]目的 探讨CYP2C19基因多态性检测指导急性冠脉综合征患者经皮冠状动脉介入（PCI）术后抗血小板精准治疗的临床效果。方法 选取2016年1月～2017年9月我院收治的80例急性冠脉综合征患者作为研究对象，采用随机数字表法分为两组，每组各40例。对照组患者实施氯吡格雷与阿司匹林的常规用药，观察组患者实施CYP2C19基因多态性检测指导用药，所有患者均随访6个月，比较两组患者的主要心血管不良事件及主要出血事件。结果 观察组患者的主要心血管不良事件发生率低于对照组（P<0.05），两组患者的主要出血事件发生率比较，差异无统计学意义（P>0.05）。结论 CYP2C19基因多态性检测指导急性冠脉综合征患者PCI术后抗血小板精准治疗的效果显著，且不增加出血事件的发生。

[关键词] CYP2C19基因多态性；急性冠脉综合征；经皮冠状动脉介入术；抗血小板精准治疗

[中图分类号] R542.2 [文献标识码] A [文章编号] 1674-4721（2018）9（a）-0063-03

[Abstract] Objective To investigate clinical effect of accurate antiplatelet therapy after PCI under CYP2C19 gene polymorphism detection guidance in patients with acute coronary syndrome. Methods A total of 80 patients with acute coronary syndrome treated in our hospital from January 2016 to September 2017 were selected as the subjects， and divided into two groups by random number table method， with 40 cases in each group. The patients in control group received routine use of clopidogrel and aspirin， and patients in observation group used drug under CYP2C19 gene polymorphism detection guidance. The patients were followed up within 6 months， and the incidence of major adverse cardiac events and major bleeding events were compared between the two groups. Results The incidence of major adverse cardiac events in observation group was lower than that in the control group （P<0.05）. There was not significant difference in incidence of major bleeding events between the two groups. Conclusion Accurate antiplatelet therapy after PCI under CYP2C19 gene polymorphism detection guidance has significant effect on patients with acute coronary syndrome， which dosen′t increase the occurrence of bleeding events.

[Key words] CYP2C19 gene polymorphism； Acute coronary syndrome； Percutaneous coronary intervention； Accurate antiplatelet therapy

急性冠脈综合征是临床常见病和多发病，具有高发病率、高死亡率、高致残率的特点[1-2]，可直接影响到患者的预后状况。诸多研究显示[3-4]，在急性冠脉综合征发生发展过程中，血小板聚集发挥着重要作用。而经皮冠状动脉介入（PCI）术虽然可以在一定程度上改善患者的临床病症，但无法改善机体血小板聚集状况，因而亟待寻求一种可以有效降低术后血小板聚集率的治疗方法，以确保患者的临床疗效。药物治疗中，氯吡格雷和阿司匹林较为常用[5-6]，但氯吡格雷反应性的个体差异较大，主要取决于其活性代谢产物的形成。CYP2C19是氯吡格雷的生物代谢酶，可经CYP450代谢活化，转化为具有活性的产物，通过抑制ADP受体依赖性的血小板糖蛋白复合物的形成，实现抑制血小板聚集，因而认为，CYP2C19基因多态性与该酶的活性关系密切。……