CYP2C19基因多态性分布及不同治疗方案对心血管不良事件的影响

目的：研究CYP2C19基因多态性及在中国人群中的分布，分析PCI术后不同治疗方案对心血管不良事件发生的影响。方法：用全血直接PCR测定我院311名患者CYP2C19基因分型，分析不同种族CYP2C19基因型的频率以及比较不同治疗方案出现的心血管不良事件。结果：野生型等位基因CYP2C19*1的频率为63.99%，突变型等位基因CYP2C19*2和CYP2C19*3的频率分别为30.87%和5.14%。不同性别对CYP2C19代谢表型分布没有显著差异（P>0.05）。在中代谢和慢代谢型患者中，个体化治疗组出现PCI术后心血管不良事件明显低于常规治疗组（P<0.05）。结论：中国人群CYP2C19*2和CYP2C19*3的突变频率远高于欧洲及美洲国家人群，与其他亚洲国家韩国和日本相近。CYP2C19基因突变使氯吡格雷活性降低，在进行冠心病的治疗时，应根据基因的多态性进行个体化治疗，减少不良反应。

Distribution of CYP2C19 gene polymorphism and the effect of different therapies on cardiovascular adverse events

OBJECTIVE To study the CYP2C19 gene polymorphism and its distribution in Chinese population, to analyze the effects of different therapies on cardiovascular adverse events after PCI. METHODS Whole blood direct PCR was used to determine the CYP2C19 genotypes among 311 patients in our hospital. We analyzed the frequency of CYP2C19 genotypes in different ethnic groups and compared the cardiovascular adverse events in different therapies. RESULTS The frequency of the wild-type allele CYP2C19*1 was 63.99%, and the frequencies of the mutant alleles CYP2C19*2 and CYP2C19*3 were respectively 30.87% and 5.14%. There was no significant difference in the distribution of CYP2C19 metabolic phenotypes between different genders(P>0.05). Among patients with intermediate and poor metabolizers, the cardiovascular adverse events after PCI in the individualized treatment group were significantly lower than those in conventional group(P<0.05). CONCLUSION The mutation frequency of CYP2C19*2 and CYP2C19*3 in Chinese population is much higher than that in European and American countries, similar to other Asian countries such as Korea and Japan. Mutation of CYP2C19 gene reduces the activity of clopidogrel. In the treatment of coronary heart disease, individualized treatment should be based on gene polymorphism to reduce adverse reactions.