CYP2C19药物基因多态性对冠心病患者抗血小板药物个体化治疗的指导

目的检测CYP2C19药物基因多态性对冠心病患者(CHD)抗血小板药物个体化治疗的指导作用。方法2016年1月至2016年12月上海同济大学附属第十人民医院心内科CHD接受PCI治疗的患者200例。这200患者分为在CYP2C19基因多态性检测指导下治疗的A组与采用常规治疗的B组,每组各100人。随后分析A、B两组冠心病患者术后1个月、6个月后发生血栓的情况。结果术后1个月,A组发生血栓的概率显著低于B组(0.2%比1.1%,P=0.036),术后6个月时,A、B两组发生血栓的概率没有统计学意义(0.6%比1.1%,P=0.223),但A组仍保持较低趋势。结论经过PCI治疗的CHD患者在CYP2C19基因多态性检测指导下,氯吡格雷低代谢患者可以得到有效的替换治疗,进而降低术后1个月的血栓发生率,但是对于长远的预后的指导价值需要进一步研究。

CYP2 C19 Gene Polymorphism in Patients with Coronary Heart Disease in the Treatment of Antiplatelet Drugs

Objective To evaluate the CYP2C19 gene polymorphisms screening guided antiplatelet therapy after percutaneous coronary intervention ( PCI ) in patients with coronary heart disease ( CHD ) . Methods From Jan 2016 to Dec 2016,a total of 200 CHD patients who were treated by PCI were from The 10 th People ' s Hospital, Tongji University, Shanghai and were sequentially randomized into 2 different groups:CYP2C19 gene polymorphisms screening group ( n =100, group A ) and without CYP2C19 gene polymorphisms screening group ( n =100, group B ).Group A was given Ticagrelo instead of Clopidogrel therapy in patients with low concentration of active metabolite of Clopidogrel during 6 months clinical follow up.The rate of thrombus patients were analyzed at 1 month and 6 months after therapy by corresponding measures .Results At 1 month follow up ,acute myocardial infarction and death rate in group B were greater than in group A (1.1% VS 0.2%,P=0.036).At 6 months follow-up,the difference of thethrombus rate between the 2 groups was no significant (group A 0.6% VS group B 1.1%,P=0.223).Conclusion For patients treated by anti-platelet therapy , the CYP2 C19 gene polymorphisms screening is contribute to the replace therapyof those patients .What's more,it can also drop the occurring rate of patients ' thrombus after 1 month ,who was treated by operation .But the impact on the further therapy needs more observation .