摘要
目的研究临床血栓弹力图检测氯吡格雷药效与CYP2C19基因型的相关性及对PCI术后氯吡格雷治疗的指导意义。方法选择2016年12月至2017年4月于我院心血管内科行PCI治疗的冠心病且术后阿司匹林和氯吡格雷双联抗血小板药物治疗的患者共230例,检测患者血栓弹力图检测结果及CYP2C19的基因型,比较氯吡格雷抵抗组和氯吡格雷敏感组患者的血小板抑制率与CYP2C19基因型的相关性。结果本实验受试者为230人,其中,氯吡格雷抵抗组（94例）和氯吡格雷敏感组（136例）; CYP2C19基因型为慢代谢型（107例）,非慢代谢型（快代谢型＋中间代谢型）共（123例）。利用血栓弹力图测定的ADP抑制率及MA-ADP相关结果,预测CYP2C19基因型的ROC曲线下面积（AUC）分别为：ADP抑制率：0. 663（95%CI：0. 598—0. 723,P〈0. 001）,当ADP抑制率取最佳临界值（31. 26%）时,诊断CYP2C19基因型为慢代谢型的敏感性为80. 49%,特异性为50. 77%; MA-ADP：0. 635（95%CI：0. 570—0. 697,P〈0. 001）,当MA-ADP取最佳临界值（26. 35）时,诊断CYP2C19基因型为慢代谢型的敏感性为56. 10%,特异性为70. 26%。结论血栓弹力图所得ADP抑制率及MA-ADP与CYP2C19慢代谢型有较好的相关性,对指导PCI术后的抗血小板治疗指导意义。
Objective To investigate the correlation between clopidogrel efficacy and the CYP2 C19 genotype via thromboelastogram（ TEG）. We hope this would help constructing valuable reference data for clopidogrel treatment after PCI.Methods A total of 230 patients with coronary heart disease undergoing PCI in the cardiovascular department of our hospital（ recorded between Dec 2016 to Apr 2017 were enrolled in this study. The sample population was treated with aspirin and clopidogrel dual antiplatelet drugs. TEG and CYP2 C19 genotyping were performed. The correlations between platelet inhibition and CYP2 C19 genotypes were analyzed by comparing the clopidogrel and clopidogrel-sensitive groups. Results According to the TEG results,the 230 patients fell into 2 categories： the clopidogrel resistance group（ 94 cases） and the clopidogrel-sensitive group（ 136 cases）. The area under the ROC curve（ AUC） of the CYP2 C19 genotype was predicted using the TEG ADP inhibition rate and MA-ADP correlation results： The ADP inhibition rate： 0. 663（ 95% CI： 0. 598-0. 723,P〈 0. 001）. With ADP being at the cut-off rate at 31. 26%,CYP2 C19 genotyping was considered as slow metabolizing type at80. 49% with a specificity of 50. 77%; MA-ADP： 0. 635（ 95% CI： 0. 570-0. 697,P 〈0. 001） With MA-ADP being at the cut-off value at 26. 35,CYP2 C19 genotyping was considered as slow metabolizing type at 56. 10% with a specificity of70. 26%. Conclusion According to the TEG tests,the genotype of CYP2 C19 presents a superior correlation with ADP-induced platelet aggregation inhibition rate and MA-ADP,which is of positive significance to guide the anti-platelet therapy after PCI treatment.
作者
高凯旋
孙小媛
刘静静
井忠翠
王燕
王海燕
GAO Kaixuan;SUN Xiaoyuan;LIU Jingjing;JING Zhongcui;WANG Yan;WANG Haiyan(Department of Blood Transfusion,the Af-filiated Hospital of Qingdao University,Qingdao,266000 China;Department of general medicine,Affiliated Hospital of Qiingdao University)
出处
《中国输血杂志》
CAS
2018年第7期735-738,共4页
Chinese Journal of Blood Transfusion
关键词
CYP2C19基因型
血栓弹力图
ADP抑制率
the genotype of CYP2C19
TEG
the ADP-induced platelet aggregation inhibition rate
