【摘要】 目的对经皮冠状动脉介入治疗(PCI)的非ST段抬高急性冠状动脉综合征(NSTEACS)患者进行CYP2C19基因多态性检测,判明有无氯吡格雷药物代谢异常,指导PCI术后选择性应用抗血小板药物,随诊观察术后1个月及6个月的主要不良心血管事件(MACE),明确基因检测指导的治疗作用。方法 2013年5月至2014年5月大连医科大学附属第一医院心内科收治NSTE-ACS并接受PCI治疗的患者486例,连续分为CYP2C19基因多态性检测指导治疗组(A组237例,若呈氯吡格雷低代谢,则用替格瑞洛替换治疗)与常规治疗组(B组249例,PCI术后常规应用氯吡格雷治疗),分析两组患者术后1个月、6个月MACE发生情况。结果 A组237例患者中,43例(18.1%)基因检测为氯吡格雷低代谢,改用替格瑞洛治疗。术后1个月时总体MACE发生率A组显著低于B组(1.3%比5.2%,P=0.031),A组心肌梗死和死亡的总发生率显著低于B组(1.3%比3.6%,P=0.041)。术后6个月时,两组总体MACE发生率比较,差异无统计学意义(4.2%比6.8%,P=0.210),但A组仍保持较低趋势。结论接受PCI治疗的NSTE-ACS患者术后进行CYP2C19基因多态性检测,有助于对氯吡格雷低代谢患者进行针对性替换治疗,从而有效降低这部分患者术后1个月的临床MACE发生率,但是对于远期预后的影响需做进一步观察。更多还原

【Abstract】 Objective To evaluate the CYP2C19 gene polymorphisms screening guided antiplatelet therapy after percutaneous coronary intervention( PCI) in patients with non ST-segment elevation acute coronary syndrome( NSTE-ACS). Methods From May 2013 to May 2014,a total of 486 patients with NSTE-ACS undergoing PCI were sequentially randomized into CYP2C19 gene polymorphisms screening group( n = 237,group A),and without CYP2C19 gene polymorphisms screening group( n = 249,group B). Ticagrelor was given instead of clopidogrel therapy in patients with low concentration of active metabolite of clopidogrel during 6 months clinical follow up. The MACE rates were analyzed at 1 month and 6 months in clinical follow up. Results In group A,there are 43 patients( 18. 1%) among 237 patients showed low concentration of active metabolite of clopidogrel by CYP2C19 gene polymorphisms screening,and Ticagrelor was given instead of Clopidogrel after PCI. At 1 month follow up,acute myocardial infarction and death rate in group B were greater than in group A( 5. 2% vs. 1. 3%,P = 0. 031). At 6 months follow-up,the MACE rate was no significant different between the 2 groups( group A 4. 2% vs. group B 6. 8%,P =0. 210). Conclusions The CYP2C19 gene polymorphisms screening guided anti-platelet therapy is beneficial to those patients with low concentration of active metabolite of clopidogrel at 1 month in patients with NSTE-ACS undergoing PCI.更多还原