CYP2C19基因型指导经皮冠脉介入治疗术后抗血小板治疗的有效性及安全性

 目的 评价细胞色素P450 2C19(CYP2C19)基因型检测指导冠心病患者经皮冠脉介入治疗(percutaneous coronary intervention,PCI)术后抗血小板治疗的有效性及安全性。方法 选择2013-04至2015-02在武警总医院心内科接受PCI的冠心病患者718例,随机分为研究组和对照组,研究组为进行CYP2C1基因型检测并调整抗血小板药物治疗组,即根据基因型结果快代谢型患者继续口服氯吡格雷75 mg,1次/d、中慢代谢型患者随机调整为氯吡格雷150 mg,1次/d或替格瑞洛90 mg,2次/d;对照组为未检测基因型的常规治疗组,即口服氯吡格雷75 mg,1次/d。观察两组患者术后6个月主要不良心血管事件(MACE事件)和出血事件的发生率。结果 术后6个月MACE事件的发生率研究组(4.7%)显著低于对照组(8.9%),且差异具有统计学意义(P=0.026)。两组出血事件发生率的差异无统计学意义(8.1% vs 6.7%,P=0.475)。结论 对于PCI术后的冠心病患者,进行CYP2C19基因型检测并调整抗血小板药物治疗可减少术后MACE事件的发生,且不增加出血性事件的发生。

Efficacy and safety of CYP2C19 genotype-guided antiplatelet therapy in patients with coronary artery disease after percutaneous coronary intervention

Objective To evaluate the efficacy and safety of CYP2C19 genotype-guided antiplatelet therapy in patients with coronary artery disease(CAD) after percutaneous coronary intervention(PCI). Methods From April 2013 to February 2015, a total of 718 patients with CAD were admitted and received PCI in the Department of Cardiology, General Hospital of Chinese People’s Armed Police Forces. They were sequentially randomized into study group (n=359) and control group (n=359). In the study group, the CYP2C19 genotypes were detected. The extensive metabolizer (EM) group received clopidogrel 75 mg, qd, the intermediate metabolizer (IM) and poor metabolizer (PM) were randomly assigned to receive either high dose clopidogrel 150 mg, qd or ticagrelor 90mg, bid. The control group routinely received clopidogrel 75 mg, qd. At 6 months, the incidence of major adverse cardiac events (MACE) and bleeding events were observed in the clinical follow up. Results At 6 months follow up, the incidence of MACE in the study group was lower than in the control group (4.7% vs 8.9%,P=0.026). There were no significant difference in the incidence of bleeding events between the two groups(8.1% vs 6.7%,P=0.475). Conclusions In patients with CAD after PCI, CYP2C19 genotype-guided antiplatelet therapy can reduce the incidence of MACE,and does not increase the risk of bleeding event.