冠心病患者CYP2C19基因多态性及临床不良事件发生与氯吡格雷抵抗的关系

目的 通过分析经皮冠状动脉介入治疗(PCI)术后冠心病患者的CYP2C19基因型结果、临床相关危险因素和主要心血管不良事件发生情况与氯吡格雷抵抗的关系,探讨影响氯吡格雷抵抗发生、发展的因素,为临床治疗提供有效依据.方法 收集2017年1月至2018年12月该院收治并进行过基因检测的346例冠心病患者资料,分析其CYP2...

Relationship between CYP2C19 gene polymorphism with clinical adverse events and clopidogrel resistance in patients with coronary heart disease

Objective To explore the factors affecting the occurrence and development of clopidegrel resistance to provide the effective basis for clinical treatment by analyzing CYP2C19 genotypes results,clinical related risk factors and major cardiovascular adverse events after PCI in the patients with coronary heart disease(CHD).Methods The data of 346 cases of CHD and genetic testing admitted and treated in this hospital from January 2017 to December 2018 were collected to analyze the distribution characteristics of CYP2C19 genotypes and metabolic types.A total of 251 patients with CHD and clopidogrel use after PCI were screened out and conducted the platelet aggregation function experiment examination.The cases were divided into clopidogrel sensitive group(MAR<50%)and clopidogrel resistance group(MAR≥50%)according to the maximum aggregation rate of platelet.The polymorphism of CYP2C19 gene was detected by fluorescence PCR.The cases were divided into extensive metabolizer(*1/*1),intermediate metabolizer(*1/*2,*1/*3)and poor metabolizer(*2/*2,*2/*3,*3/*3)according to the results of genotype.The proportions of the patients,related risk factors,and clinical cardiovascular adverse event occurrence were compared among different metabolic types in the clopidogrel resistance group and clopidogrel sensitive group.Results MAR in the patients with poor metabolizer was higher than that in the patients with extensive and intermediate metabolizer(P<0.05).Among 251 finally included cases,the CYP2C19 metabolizers in the clopidogrel resistance group had 38 cases(34.6%)of extensive metabolizer,57 cases(51.8%)of intermediate metabolizer and 15 cases(13.6%)of poor metabolizer.The difference in the patients proportion of extensive metabolizer between the clopidogrel resistance group and clopidogrel sensitive group was statistically significant(P<0.05).The propotion of patients with hypertension in the clopidogrel resistance group was significant higher than that in the clopidogrel sensitive group(91.8%vs.63.8%,P<0.05).The incidence rate of clinical cardiovascular adverse events in the clopidogrel resistance group was higher than that in the clopidogrel sensitive group,and the difference was statistically significant(94.5%vs.84.4%,P<0.05).Conclusion CYP2C19 gene mutation and hypertension may be two important factors of clopidogrel resistance occurrence,moreover clopidogrel increases the risk of clinical cardiovascular adverse events occurrence after PCI in the patients with CHD.