基因导向的氯吡格雷和替格瑞洛对急性冠脉综合征患者PCI术后炎症因子、血小板聚集和预后的影响

目的:探讨CYP2C19基因检测对急性冠脉综合征(ACS)经皮冠状动脉介入治疗(PCI)患者术后氯吡格雷用药的指导作用.方法:入选2016年1月至2018年12月入住郑州中心医院心血管内科ACS并行PCI采用药物洗脱支架植入的患者787例为研究对象,进行前瞻性队列研究,按是否进行CYP2C19基因检测,分为氯吡格雷组(...

Effects of gene-directed clopidogrel and tegrarol on inflammatory factors,platelet aggregation and prognosis in patients with acute coronary syndrome after percutaneous coronary intervention

OBJECTIVE To explore the role of CYP2C19 gene detection in the treatment of clopidogrel in patients with acute coronary syndrome(ACS)after percutaneous coronary intervention(PCI).METHODS A prospective cohort study was conducted for 787 patients with ACS and PCI using drug-eluting stent implantation from January 2016 to December 2018.They were divided into the groups of clopidogrel(A),gene-directed clopidogrel(B)and tegrilol(C)according to whether or not there was consent to CPY2C19 gene test.Group B was divided into super fast and fast metabolism type(group B1),intermediate metabolism type(group B2)and slow metabolism type(group B3)according to CYP2C19 genotype.Dual antiplatelet therapy was offered until one year post-operation.Group B was treated according to CYP2C19 genotype.The levels of hs-CRP,IL-6,TNF-αand platelet aggregation rate were measured before and after PCI.The major adverse cardiovascular events,bleeding events and related adverse reactions were recorded by telephone follow-up at one year after PCI and efficacy and safety were evaluated.RESULTS The levels of hs-CRP,IL-6 and TNF-αwere significantly lower in groups B and C than those in group A(P<0.05).No significant differences existed in the levels of hs-CRP,IL-6 and TNF-αamong groups B1,B2 and B3 for 24 h and 7 days after PCI(P>0.05).The platelet aggregation rate was significantly lower in group B/C than that in group A(P<0.05).Significant difference existed in normal reactive type and non-reactive type of antiplatelet aggregation drugs among groups A,B and C(P<0.05).No significant difference existed in reaction type of antiplatelet aggregation drugs among groups B1,B2 and B3(P>0.05).Significant differences existed in the incidence of secondary end point events and bleeding events among groups A,B and C(P<0.01)and the incidence of secondary endpoint events and revascularization were significantly higher in group A than those in group B/C(P<0.05).The incidence of small bleeding events,dyspnea or respiratory suppression in group C was significantly higher than those in group A/B(P<0.05).CONCLUSION CPY2C19 gene detection may guide the use of clopidogrel in ACS patients undergoing PCI.It can reduce markedly the level of inflammatory factors,inhibit platelet aggregation and reduce the incidence of secondary adverse events.It is of clinical significance.