摘要
目的探讨CYP2C19基因型对冠心病患者经皮冠状动脉介入治疗(PCI)后抗血小板治疗结果的影响。方法选取2018年6月至2021年6月北京王府中西医结合医院接受住院的971例接受PCI手术的冠心病患者作研究对象。根据基因分型结果和临床特征确定抗血小板治疗方案,将患者分为氯吡格雷组(n=724)和替格瑞洛组(n=247)。氯吡格雷组患者术后口服氯吡格雷(75 mg)每日1次,阿司匹林(0.1 g)每日1次;替格瑞洛组患者术后口服替格瑞洛(90 mg)每日2次,阿司匹林(0.1 g)每日1次。观察两组中不同基因型患者出血和主要心血管不良事件(MACEs)的发生情况。结果替格瑞洛组的出血发生率高于氯吡格雷组,差异有统计学意义(P<0.05);两组的MACEs发生率比较,差异无统计学意义(P>0.05)。氯吡格雷组中,非常缓慢代谢型患者的MACEs总发生率高于快速代谢型及缓慢代谢型患者,差异有统计学意义(P<0.017)。替格瑞洛组中,快速代谢型患者的出血总发生率高于缓慢代谢型及非常缓慢代谢型患者,差异有统计学意义(P<0.017)。结论氯吡格雷和替格瑞洛对PCI后预防MACEs发生方面效果相当。接受氯吡格雷治疗的CYP2C19基因非常缓慢代谢型患者,其预防MACEs发生的效用较低;接受替格瑞洛治疗的CYP2C19基因快速代谢型患者,其出血发生率较高。临床可以根据CYP2C19基因分型采取个体化治疗,以优化PCI术后患者抗血小板治疗的效果。
Objective To investigate the effect of CYP2C19 genotype on the outcome of antiplatelet therapy in patients with coronary heart disease after percutaneous coronary intervention(PCI).Methods A total of 971 patients with coronary heart disease who underwent PCI in Beijing Royal Integrative Medicine Hospital from June 2018 to June 2021 were selected as the research objects.Antiplatelet therapy was determined according to the genotyping results and clinical characteristics,and the patients were divided into Clopidogrel group(n=724)and Ticagrelor group(n=247).Patients in Clopidogrel group were treated with Clopidogrel(75 mg)once daily and Aspirin(0.1 g)once daily after surgery,and patients in Ticagrelor group received Ticagrelor(90 mg)twice a day and Aspirin(0.1 g)once daily after surgery.The incidences of bleeding and major adverse cardiovascular events(MACEs)were observed in patients with different genotypes in the two groups.Results The incidence of bleeding in Ticagrelor group was higher than that in Clopidogrel group,and the difference was statistically significant(P<0.05).There was no significant difference in the incidence of MACEs between the two groups(P>0.05).In the Clopidogrel group,the total incidence of MACEs in patients with very slow metabolism was higher than those in patients with rapid metabolism and slow metabolism,and the differences were statistically significant(P<0.017).In the Ticagrelor group,the total incidence of bleeding in patients with rapid metabolism was higher than those in patients with slow metabolism and very slow metabolism,and the differences were statistically significant(P<0.017).Conclusion Clopidogrel and Ticagrelor are equally effective in preventing MACEs after PCI.The efficacy of Clopidogrel in preventing MACEs is lower in patients with very slow CYP2C19 metabolizers.The incidence of bleeding is higher in CYP2C19 rapid metabolizer patients treated with Ticagrelor.Clinical treatment can be individualized according to CYP2C19 genotype to optimize the effect of antiplatelet therapy in patients after PCI.
作者
耿二冬
宁涓
GENG Erdong;NING Juan(Department of Cardiovascular Medicine,Beijing Royal Integrative Medicine Hospital,Beijing102200,China;Department of Internal Medicine,Haidian Section of Peking University Third Hospital,Beijing100080,China)
出处
《中国当代医药》
CAS
2024年第5期60-63,76,共5页
China Modern Medicine
