细胞色素P450 3A4+894C＞T基因多态性与急性冠脉综合症患者冠状动脉介入术预后的关系

目的 探讨急性冠脉综合征(ACS)患者血浆细胞色素P450 3A4(CYP3A4)894C＞T基因多态性与接受经皮冠状动脉介入(PCI)治疗后患者心脏不良事件再发风险的关系.方法 入选275例接受标准双联抗血小板及PCI术治疗的ACS患者.在服用抗血小板药物前及7d后检测每位患者的血小板聚集率(PAR).采用基因芯片及PCR技术检测每组内患者CYP3A4基因894C＞T单核苷酸多态性的基因型和等位基因分布.通过PCI术明确患者的冠脉病变数目并计算其Gensini评分.出院后随访3～12月.结果 CYP3A4基因多态性在氯吡格雷抵抗(CR)组和非氯吡格雷抵抗(NCR)组的差异无统计学意义(P＞0.05).多因素Logistic回归分析显示,CYP3A4基因894C＞T位点中携带T突变基因与ACS患者发生CR的相关性差异无统计学意义(OR1.359,P＞0.05).随访3～12月后,CR组较NCR组均有更高的心血管事件发生率(P＜0.05),但与CYP3A4基因894C＞T位点的突变类型无关.结论 CYP3A4基因894C＞T位点的多态性对ACS患者PCI术后抗血小板效应及心血管发生风险无明确指导意义.

Correlation between cytochrome 3A4+894C＞T P450 gene polymorphism and outcomes of coronary intervention in patients with acute coronary syndrome

Objective To investigate the relationship between plasma cytochrome P450 3A4 (CYP3A4) 894C＞T gene polymorphism and the risk of recurrence of adverse cardiac events after percutaneous coronary intervention (PCI) in patients with acute coronary syndrome (ACS).Methods A total of 275 patients with ACS received standard dual antiplatelet therapy and PCI.Platelet aggregation rate (PAR) was detected in each patient before and 7 days after administration of the anti-platelet drugs.Single nucleotide polymorphism of CYP3A4 gene 894C＞T was detected with PCR and microarray technique.The number of coronary artery lesions was determined by PCI and the Gensini score was calculated.The patients were followed up for 3-12 months after discharge.Results No significant difference was found in CYP3A4 gene polymorphism between patients with clopidogrel resistance (CR group) and those without CR (NCR group) (P＞0.05).Multivariate logistic regression analysis showed that CYP3A4 gene 894C＞T polymorphism was not correlated with CR in patients with ACS (OR 1.359,P＞0.05).During the follow-up,the incidence of cardiovascular events was significantly higher in CR group than in NCR group (P＜0.05),but this difference was not related to the mutation type of 894C＞T locus of CYP3A4 gene.Conclusion The CYP3A4 gene 894C＞T polymorphism is not associated with the effect of anti-platelet therapy and the risk of cardiovascular event in patients with ACS following PCI.