CYP2C19基因型指导下的抗血小板治疗在CABG术后的应用进展

冠状动脉旁路移植术后的抗血小板治疗是重要的药物治疗之一，它在改善患者桥血管通畅率以及减少患者术后主要心血管不良事件（MACE）发生发挥着积极的作用。临床上发现一些患者对常用的抗血小板药物氯吡格雷存在抵抗，导致术后桥血管狭窄及MACE事件的发生率增高，这种抵抗可能与细胞色素P450 2C19（CYP2C19）基因多态性有关。而第三代P2Y12受体拮抗剂的抗血小板效果不受CYP2C19基因型的影响。有专家共识推荐进行CYP2C19基因型检测来确定双抗治疗方案，那么依据CYP2C19基因型检测的个体化治疗方案是否可以降低患者术后的主要心血管不良事件的发生率？本文将从氯吡格雷抵抗与CYP2C19基因型的关系、冠状动脉旁路移植术后抗血小板治疗现状及现有专家共识推荐等几方面进行回顾与分析。

Application progress of CYP2C19 Genotype-Guided Antiplatelet Therapy after Coronary Artery Bypass Grafting

Antiplatelet therapy after coronary artery bypass grafting is one of the important drug treatments, which plays an active role in improving the rate of venous bridge patency and reducing the incidence of major adverse cardiovascular events (MACE). Currently, it has been found that some patients have resistance to the commonly used anti-platelet drug clopidogrel, leading to the increased incidence of postoperative vascular bridge stenosis and MACE events, which may be related to the polymorphism of CYP2C19 gene. However, the anti-platelet effect of the third-generation P2Y12 receptor antagonist was not affected by the CYP2C19 genotype. There is an expert consensus that CYP2C19 genotype testing is recommended to determine the dual antibody treatment regimen, so can the individualized treatment regimen based on CYP2C19 genotype testing reduce the incidence of major postoperative cardiovascular adverse events in patients? This paper will review and analyze the relationship between clopidogrel resistance and CYP2C19 genotype, the status quo of anti-platelet therapy after coronary artery bypass grafting and the existing expert consensus recommendation.