The rational use of antiplatelet drugs guided by CYP2C19 genotyping in patients with coronary heart disease after PCI
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摘要: 目的 探索CYP2C19基因指导冠心病患者经皮冠状动脉介入（PCI）术后抗血小板药物的合理使用。 方法 利用医院管理信息系统，收集2015年12月至2016年12月在心内科住院的冠心病患者2 836例，从中选取符合标准的CYP2C19 IM和PM基因型患者480例，根据患者是否根据基因型改变治疗方案，将患者分为常规剂量氯吡格雷组（常规治疗组）、氯吡格雷剂量加倍组和替格瑞洛组，观察各组患者血小板聚集抑制率和1年内主要不良心血管（MACE）及出血事件发生率。 结果 最终入选468例患者，替格瑞洛组和剂量加倍组的血小板聚集抑制率均高于常规治疗组（P<0.05），且替格瑞洛组又明显高于剂量加倍组（P<0.05）。MACE事件发生率方面，各组患者均是再发心肌梗死发生率最高，且替格瑞洛组及剂量加倍组明显低于常规治疗组（P<0.017），其余MACE各事件及出血发生率各组之间无差异性（P>0.017）。 结论 CYP2C19基因指导下冠心病患者PCI术后抗血小板治疗临床效果较好，临床应根据患者基因特点进行个体化合理用药。Abstract: Objective To explore the rational use of antiplatelet agents in patients with coronary heart disease after PCI guided by CYP2C19 genotyping. Methods Using the hospital management information system, 2 836 patients with coronary heart disease hospitalized in the Department of Cardiology from December 2015 to December 2016 were collected. Among them, 480 patients with CYP2C19 IM and PM genotypes met the criteria and were selected for the study. Patients were divided into conventional treatment group, double clopidogrel dose group and ticagrelor group based on the treatment plans according to genotype. The inhibition rate of platelet aggregation, major adverse cardiovascular event (MACE) and incidence of bleeding within one year were observed in each group. Results In the finally selected 468 patients, the platelet aggregation inhibition rate in ticagrelor group and the double clopidogrel dose group was higher than the conventional treatment group (P<0.05). The inhibition rate was significantly higher in ticagrelor group than the double clopidogrel dose group (P<0.05). The incidence of recurrent angina was highest in each group as MACE and significantly lower in double clopidogrel dose group and ticagrelor group than that in conventional treatment group(P<0.017). There was no significant difference in each group in terms of other MACE and incidence of bleeding (P>0.017). Conclusion The patients with coronary heart disease exhibited better therapeutic results from antiplatelet treatments guided with CYP2C19 genotyping. Individualized medication regimen should be implemented clinically according to the patient's genetic characteristics.
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Key words:
- clopidogrel /
- CYP2C19 /
- individualization /
- ticagrelor
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