【摘要】 目的 观察经皮冠状动脉介入(PCI)术后使用氯吡格雷6个月后其高血小板反应发生率及其与CYP2C19基因多态性的关系。方法 入选2012年6月至9月行PCI治疗的冠心病患者47例,术前顿服氯吡格雷300mg、阿司匹林300mg负荷剂量,术后予维持剂量治疗。检测术后6个月最大血小板聚集率(MPA),直接测序法检测CYP2C19基因多态性。将观察对象分为血小板高反应性(HPR)组和非血小板高反应性(nHPR)组,检测血细胞计数、纤维蛋白原、超敏CRP等及CYP2C19基因多态性与HPR的关系。结果 HPR17例,nHPR 30例。CYP2C19基因表型强代谢者21例,一般代谢者18例,弱代谢者8例。HPR组,EMs6例(35.3%),IMs6例(35.3%),PMs5例(29.4%);nHPR组,EMs15例(50.0%),IMs12例(40.0%),PMs3例(10.0%)。HPR、nHPR组2μmol/L、5μmol/L ADP诱导MPA比较差异有统计学意义(P<0.01)。EMs、IMs、PMs组间MPA、HPR比较有增高趋势,但差异无统计学意义(P>0.05)。结论 PCI术后患者中接受氯吡格雷治疗的HPR普遍存在。CYP2C19基因检瓣测相关代谢型与HPR无明确相关性。更多还原

【Abstract】 Objective We aimed to investigate the relationship between cytochrome(CYP)2C19*2,*3 polymorphisms and high ontreatment platelet reactivity(HPR) in patients treated with percutaneous coronary interventions(PCI) and dual antiplatelet therapy over a 6-month period.Methods Totally 47 patients post-PCI were enrolled from June 2012 to September 2012.Patients received a 300 mg loading dose(LD)clopidogrel and aspirin before PCI,then continued with maintenance dose(MD) as dual antiplatelet therapy.Max platelet aggregation(MPA)was assessed in post-PCI patients after 6 months.Direct sequence was used to genotype the CYP2CI9*2、 CYP2C19*3 polymorphisms in these patients.HPR was defined as MPA>46%,whereas those having<46%were nHPR.According to CYP2C19 polymorphism,we examined MPA and HPR in different phenotype.Results HPR was present in 36.2%patients.The phenotype of CYP2C19 includes EMs 44.7%(n=21),IMs 38.3%(n=18) and PMs 17.0%(n=8).In HPR group and nHPR group,there were EMs 35.3%(n=6),50.0%(n=15),IMs 35.3%(n=6),40.0%(n=12),PMs 29.4%(n=5),10.0%(n=3),respectively.There’ s no statistic differences among EMs,IMs,PMs in MPA and HPR distribution.Conclusion HPR is common in patients received clopidogrel after PCI.There is no substantial interaction between CYP2C19 polymorphism and platelet reactivity on clopidogrel.更多还原