CYP2C19基因不同代谢速度对冠心病患者PCI治疗后抗血小板治疗方案及预后的影响

目的分析CYP2C19基因不同代谢速度对冠状动脉粥样硬化性心脏病(冠心病)患者经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗后抗血小板治疗方案及预后的影响。方法选取2015年3月至2017年3月沧州中西医结合医院108例行PCI治疗的冠心病患者,PCI治疗后对其进行CYP2C19基因检测,包括中慢代谢患者60例,将其分为A组(30例)给予氯吡格雷75 mg/d,B组(30例)给予替格瑞洛90 mg,2次/d;快代谢患者48例为C组,给予氯吡格雷150 mg/d。比较3组患者行PCI治疗前后血小板聚集率与不良反应的发生情况。结果B组患者术后血小板聚集率明显低于其他两组,差异有统计学意义(P<0.05);A组患者与C组血小板聚集率比较,差异无统计学意义(P>0.05)。B组患者出血发生率明显低于其他两组,差异有统计学意义(P<0.05);A组患者不良反应发生率与C组比较,差异无统计学意义(P>0.05)。结论CYP2C19基因不同代谢速度的冠心病患者PCI治疗后给予不同剂量的氯吡格雷进行常规治疗的疗效并无明显差异,但替格瑞洛能够有效减轻血小板聚集率,有效降低不良反应发生率,且不会增加出血的发生率。

Effects of CYP2C19 gene of different metabolic rate on antiplatelet therapy and prognosis in patients with coronary heart disease after percutaneous coronary intervention

Objectives To analyze the CYP2 C19 gene of different metabolic rate on the antiplatelet therapy and prog-nosis in patients with coronary heart disease(CHD)after percutaneous coronary intervention(PCI).MethodsTotally108 patients with CHD after PCI were selected in Cangzhou Hospital of Integrated Traditional Chinese and WesternMedicine from March 2015 to March 2017.The CYP2 C19 gene of all the patients was detected,including 60 patientswith slow metabolism,who were divided into group A(30 cases)treated with clopidogrel for 75 mg/d and group B(30 cases)receiving ticagrelor for 90 mg,2 times/d;48 patients with fast metabolism as group C undergoing clopido-grel for 150 mg/d.The rates of platelet aggregation and adverse reactions before and after PCI were compared among thethree groups.ResultsPostoperative platelet aggregation rate in group B was significantly lower than those of the othertwo groups(P both<0.05),while there was no significant difference of platelet aggregation rate between group A andgroup C(P>0.05).The incidence rate of bleeding in group B was significantly lower than those of the other two groups(P<0.05),while there was no significant difference of adverse reaction incidence rate between group A and group C(P>0.05).ConclusionsDifferent dosage of clopidogrel in the treatment of CHD patients with CYP2 C19 gene in differ-ent metabolic rate after PCI shows no significant difference,but ticagrelor can effectively reduce platelet aggregation,reduce the incidence rate of adverse reactions,and will not increase the incidence rate of bleeding.