基因分型指导下的急性冠脉综合征行PCI患者抗血小板治疗的研究

目的：探讨细胞色素P450C19基因（CYP2C19＊2）分型指导下急性冠脉综合征（ACS）行PCI患者抗血小板治疗的临床疗效。方法：入选180例行PCI的ACS患者，根据CYP2C19＊2等位基因突变情况分为无缺失功能等位基因的野生型组（GG，92例）：进行常规双联抗血小板治疗；有缺失功能等位基因的突变杂合型组（AG，67例）：在常规双联抗血小板治疗基础上加用西洛他唑50rag，2次／a；突变纯合型组（AA，21例）：在常规双联抗血小板治疗基础上加用西洛他唑100mg，2次／d；监测血小板聚集率的变化并比较三组不良心血管事件（MAcE）及出血事件的发生情况。结果：ACS患者中的野生型占51．11％，突变杂合型占37．22％、突变纯合型占11．67％。据基因型所分三组临床资料及PCI结果无显著差异。AA组、AG组用药后7d，用药后180d的血小板聚集率均较GG组明显降低[180d：（24．3±3．41）％、（25．8±2．89）％比（30．3±3．17）％，P〈0．05]。随访12月，三组的MACE及出血事件发生率无明显差异。结论：三联抗血小板治疗用于CYP2C19＊2有缺失功能等位基因（AG或AA）的ACS患者，和双联抗血小板治疗用于CYP2C19＊2无缺失功能等位基因的ACS患者比较，血小板聚集率显著降低，但临床效果和安全性相同。CYP2C19＊2基因分型可以为个体化抗血小板治疗提供参考。

Study for antiplatelet therapy under guidance of CYP2C19 genotyping in patients with acute coronary syndrome and undergoing PCI

Objective： To explore antiplatelet therapy curative effects in patients with acute coronary syndrome （ACS） and undergoing percutaneous coronary intervention （PCI） under guidance of cytochrome P450 C19 genoty- ping （CYP2C19 ＊ 2）. Methods： According to CYP2C19＊ 2 mutant alleles, a total of 180 ACS patients undergoing PCI were divided into wild-type group carrying CYP2C19 ＊ 2 no- missing function alleles EGG group, n = 92, re- ceived routine dual antiplatelet （RDA） therapy], mutant heterozygous group carrying CYP2C19 ＊ 2 missing function alleles （AG group, n = 67, received cilostazol 50 rag, twice a day based on RDA therapy）, and mutant homozy- gotes group carrying CYP2C19 ＊ 2 missing function alleles （AA group, n = 21, received cilostazol 100 mg, twice a day based on RDA therapy）. Change of platelet aggregation rate was monitored and incidence of major adverse car- diovascular events （MACE） and bleeding event were compared among three groups. Results： Among 180 ACS pa- tients, the wild-type （GG） group AG group and AA group occupied 51.11%, 37.22% and 11.67% respectively. There were no significant differences in clinical data and PCI results among three groups. On 7th and 180th d after ad- ministration, platelet aggregation rates of AA group and AG group were significantly lower than that of GG group E180d.. （24. 3 ± 3.41） %, （25.8 ± 2.89） % vs. （30.3 ± 3.17） %, P〈0.05]. After 12-month follow-up, there were no significant differences in incidence rates of MACE and bleeding event among three groups. Conclusion： Corn-pared with dual antiplatelet therapy for CYP2C19 ＊ 2 no-missing function alleles （GG type）, the platelet aggregation rates significantly decrease, clinical efficacy and safety were no significant difference in triple antiplatelet therapy for CYP2C19 ＊ 2 missing function alleles （AG or AA type） in ACS patients.