冠心病介入术后氯吡格雷低反应性与 CYP2 C19基因多态性的关系-论文.pdf

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1、580武警医学20[5年6月第26卷第6期MedJChinPAPF，Vo1．26，No．6，June，2015冠心病介入术后氯吡格雷低反应性与CYP2C19基因多态性的关系孙亚勤一，杨胜利，杨勇【摘要】目的探讨冠心病(coronaryarterydisease，CAD)介入术后氯吡格雷低反应发生与CYP2C19幕冈多态忡的关系。方法选取武警总医院心内科行经皮冠状动脉介入治疗(percutaneouscoronaryintervention，PCI)患者200例，术后给予阿司匹林和氯吡格雷双联抗血小板药，并经『f【L栓弹力图检测二磷酸腺苷(ad

2、enosinediphosphate，ADP)诱导的I(1t／b板抑制率，按ADP诱导的血小板抑制率是否小于30％，将患者分为氯吡格雷低反应组和氯吡格雷敏感组；同时采用基因芯片技术检测CYP2C19基因多态性，判断对氯吡格雷的反应性的影响。结果CYP2CI91／l与CYP2C19$1／2、CYP2C19$1／1与CYP2C192／2、快与中间代谢型比较ADP的抑制率有统计学差异；共79例(39．5％)发生氯吡格雷低反应。氯吡格霄敏感组快代埘型者(基因型1／1)多于低反应组(P=0．013)，氯吡格雷低反应组中慢代谢型较多(P=0．013)，蒡

3、异均有统计学意义。其他代谢型间比较无差异。结论冠心病PCI术后氯吡格雷低反应与CYP2CI9基因多态性相关，携带中慢代谢型基因者发生氯吡格雷低反应较多。【关键词】CYP2C19基因多态性；ADP诱导的血小板抑制率；冠心病【中国图书分类号1R541．4CorrelationbetweenclopidogrellowresponseandCYP2C19genepolymorphisminCADpatientsafterPCISUNYaqin一，YANGShengli，andYANGYong．1．XinxiangMedicalUniversity，

4、Xinxiang453003，China；2．DepartmentofCardiology，theGener~HospitalofChiensePeople’sArmedPoliceForces，100039Beijing，China【Abstract】ObjectiveTostudythecorrelationbetweenclopidogrellowresponeandCYP2C19genepolymorphismincoronaryarterydisease(CAD)patientsafterpercutaneouscoronaryin

5、tervention(PCI)．MethodsAtotalof200patientswithCADadmittedtothishospitalfromOctober2013toOctober2014wereincludedinthisstudy，andtreatedwithdualantiplateletdrugs，aspirinandclopi—dogrelafterPCI．TheclopidogrelresponsewasjudgedbydependingontheADP—inducedplateletinhibitionratetest

6、edbythromboelas—togram(TEG)．InthisstudytheADP—inducedplateletinhibitionratelessthan30％wasdefinedasclopidogrellowresponeandthegenechipdetectiontechnologywasusedtodetectthegenotyesofCYP2C19tofurtherexploreitseffectonclopidogrelrespone．ResultsInthese200patients，theADP—inducedp

7、lateletinhibitionratewasstatisticallysignificantlydifferentbetweenpatientscarry—ingCYP2C19$1／landCYP2C19$1／2、CYP2C191／1andCYP2CI9$2／2、extensiveandintermediatemetabolizers．Thetotaloccnrenceofelopidogrellowresponsewas39．5％(79patients1．Therewassignificantdifferencebetweenclopi

8、dogrellowre—sponeandCYP2C19genotyes、metabolizers，indicatingthatmorecarrierswithext