CYP2C19基因型功能缺失患者介入术后抗血小板治疗

目的：评价CYP2C19基因型功能缺失患者介入术后不同抗血小板治疗方案的安全性及有效性。方法：纳入择期冠脉支架植入术后行CYP2C19基因型检测的患者，按其表型分为快代谢组，中代谢组及慢代谢组，将中代谢组随机分为氯吡格雷双倍剂量组和氯吡格雷常规剂量联用西洛他唑组，慢代谢组随机分为替格瑞洛组和氯吡格雷常规剂量联用西洛他唑组，另设快代谢氯吡格雷常规剂量组为对照组，连续用药6个月，随访其临床事件。结果：所有患者中CYP2C19基因快、中、慢代谢型的比例分别为25%，60%， 15%；中代谢型患者使用氯吡格雷双倍剂量方案或氯吡格雷常规剂量联用西洛他唑方案、慢代谢患者使用替格瑞洛方案，可取得与快代谢型患者常规剂量氯吡格雷方案相似的疗效，但慢代谢患者使用氯吡格雷常规剂量联用西洛他唑预防心脏缺血的获益不佳，劣于替格瑞洛方案。结论：择期冠脉支架植入术后的中代谢患者在服用阿司匹林的基础上，采用氯吡格雷双倍剂量或氯吡格雷常规剂量联用西洛他唑的方案可能有益；慢代谢型患者建议使用替格瑞洛。

Antiplatelet therapy after percutaneous coronary intervention in patients without functions of CYP2C19 alleles

OBJECTIVE To evaluate efficacy and safety of different antiplatelet therapies in patients without functions of CYP2C19 alleles after percutaneous coronary intervention.METHODS Patients with genotypes detected after PCI were divided into three groups:ultra, intermediate and poor metabolizers.Intermediate metabolizers were randomly divided into 150 mg·d^-1 clopidogrel group and 75 mg·d^-1 clopidogrel+cilostazol 50-100 mg bid group.Poor metabolizers were randomly divided into ticagrelor 90 mg bid group and 75 mg·d^-1 clopidogrel+cilostazol 50-100 mg bid group.Other ultra metabolizers receiving 75 mg·d^-1 clopidogrel were served as control.All the above therapies were prescribed for 6 months, and clinical presentations were observed at the end of treatment.RESULTS Percentage for ultra, intermediate and poor metabolizers were 25%, 60% and 15%, respectively.Intermediate metabolizers receiving 150 mg·d^-1 clopidogrel or 75 mg·d^-1 clopidogrel+cilostazol 50-100 mg bid and poor metabolizers receiving ticagrelor 90 mg bid achieved similar efficacy as ultra metabolizers receiving 75 mg·d^-1 clopidogrel.Poor metabolizers receiving 75 mg·d^-1 clopidogrel +cilostazol 50100 mg bid achieved inferior efficacy to ultra metabolizers receiving 75 mg·d^-1 clopidogrel.CONCLUSION For patients after PCI, intermediate metabolizers are suggested to take 50 mg·d^-1 clopidogrel or 75 mg·d^-1 clopidogrel+cilostazol 50-100 mg bid.Poor metabolizers are suggested to take ticagrelor 90 mg bid.