摘要
目的探讨扬州地区冠心病经皮冠状动脉介入治疗(PCI)术后患者CYP2C19基因多态性分布差异及其对抗血小板治疗效果的影响。方法回顾性选取扬州地区2021年1月—2022年12月收治的215例PCI住院冠心病患者作为研究对象,男152例、女63例,年龄37~93岁。采用聚合酶链反应-焦磷酸测序法检测患者CYP2C19基因型,观察性别、年龄与CYP2C19基因多态性分布的关系。根据CYP2C19代谢类型和术后服用抗血小板药物的不同,将患者分为快代谢型氯吡格雷组、中慢代谢型氯吡格雷组、快代谢型替格瑞洛组、中慢代谢型替格瑞洛组,随访6个月后比较各组心血管缺血不良事件、出血不良事件发生率及严重程度。结果215例患者CYP2C19基因型分别为CYP2C19*1/*1基因型81例、CYP2C19*1/*2基因型93例、CYP2C19*1/*3基因型10例、CYP2C19*2/*2基因型25例、CYP2C19*2/*3基因型6例,CYP2C19代谢类型为快代谢型81例(37.67%)、中间代谢型103例(47.91%)和慢代谢型31例(14.42%)。不同性别患者CYP2C19基因型分布频率比较,差异无统计学意义(χ^(2)=0.346,P=0.987);不同性别患者的代谢型分布频率比较,差异无统计学意义(χ^(2)=0.342,P=0.843);不同年龄段患者的代谢型分布频率比较,差异无统计学意义(χ^(2)=1.098,P=0.895)。快代谢型氯吡格雷组、快代谢型替格瑞洛组的心血管缺血不良事件发生率分别为16.67%、14.29%,差异无统计学意义(P>0.05);中慢代谢型氯吡格雷组心血管缺血不良事件发生率高于中慢代谢型替格瑞洛组,差异有统计学意义(P<0.05)。各组出血不良事件发生率比较,差异无统计学意义(P>0.05)。结论扬州地区冠心病PCI术后患者的CYP2C19基因呈多态性分布,但分布情况与性别、年龄无显著关联。CYP2C19代谢类型主要为中间代谢型、快代谢型,根据CYP2C19基因检测结果选用精准的抗血小板治疗方案对冠心病PCI患者具有重要的临床意义。
Objective To investigate the distribution differences of cytochrome P4502C19(CYP2C19)gene polymorphisms and its impact on antiplatelet therapy in patients with coronary artery disease undergoing percutaneous coronary intervention(PCI)in Yangzhou region.Methods A total of 215 patients diagnosed with coronary heart disease who underwent PCI from January 2021 to December 2022 in Yangzhou region were retrospectively selected as study objects.The age of the patients ranged from 37 to 93 years,with 152 males and 63 females.Polymerase chain reaction-sequencing was used to detect the CYP2C19 genotypes in the patients.The relationships of gender and age with distribution of CYP2C19 gene polymorphism were observed.Based on the metabolic types of CYP2C19 and the antiplatelet drugs used post-operatively,the patients were divided into fast-metabolizing clopidogrel group,medium-slow metabolizing clopidogrel group,fast-metabolizing ticagrelor group,medium-slow metabolizing ticagrelor group.After 6 months of follow-up,the incidence rates and severity of adverse events of cardiovascular ischemia and bleeding were compared among groups.Results The CYP2C19 genotypes of 215 patients were distributed as follows:81 cases of CYP2C19*1/*1 genotype,93 cases of CYP2C19*1/*2,10 cases of CYP2C19*1/*3,25 cases of CYP2C19*2/*2,6 cases of CYP2C19*2/*3.CYP2C19 metabolite types were fast metabolizers in 81 cases(37.67%),intermediate metabolizers in 103 cases(47.91%)and slow metabolizers in 31 cases(14.42%).The proportion of extensive metabolizers of CYP2C19 in the study patients was 37.67%,intermediate metabolizers accounted for 47.91%,and poor metabolizers accounted for 14.42%.There was no significant difference in the distribution of CYP2C19 genotype between different genders(χ^(2)=0.346,P=0.987).There was no significant difference in the distribution of metabolic type between different genders(χ^(2)=0.342,P=0.843).There was no significant difference in the distribution frequency of metabolic type among different age groups(χ^(2)=1.098,P=0.895).The incidence of cardiovascular ischemia of adverse events in the fast-metabolizing clopidogrel group and the fast-metabolizing ticagrelor group was 16.67%and 14.29%,respectively,no significant difference was observed(P>0.05).The incidence of cardiovascular ischemia of adverse events in the medium-slow metabolized clopidogrel group was higher than that in the medium-slow metabolized ticagrelor group,and the difference was statistically significant(P<0.05).There was no significant between-group difference in the incidence of bleeding of adverse events among groups(P>0.05).Conclusion In patients undergoing PCI for coronary heart disease in Yangzhou region,there is a polymorphism in the CYP2C19 gene with no significant differences between genders and age groups.The intermediate and fast metabolizers are more prevalent.It is clinically significant to perform CYP2C19 gene testing and adopt precise antiplatelet therapy for such patients.
作者
张钊源
何胜虎
刘佳
张晶
ZHANG Zhaoyuan;HE Shenghu;LIU Jia;ZHANG Jing(Clinical Medical College of Yangzhou University,Yangzhou,Jiangsu,225009;Department of Cardiology,Northern Jiangsu People's Hospital of Jiangsu Province,Yangzhou,Jiangsu,225001;Department of Pharmacy,Northern Jiangsu People's Hospital of Jiangsu Province,Yangzhou,Jiangsu,225001)
出处
《实用临床医药杂志》
CAS
2023年第23期17-21,共5页
Journal of Clinical Medicine in Practice
基金
江苏省研究生科研与实践创新计划资助项目(SJCX23-2024)。
