【摘要】 目的探讨CYP450酶中CYP2C19基因多态性与冠心病患者服用氯吡格雷产生低反应之间的相关性。方法选取2013年3月至2014年1月于心内科住院治疗的82例冠心病患者,其中包括急性冠脉综合征和择期行支架置入术的患者,给予负荷剂量氯吡格雷300 mg,次日起75 mg/d维持治疗。依据血小板抑制率分为氯吡格雷低反应组(CLR)31例和氯吡格雷正常反应组(NCLR)51例。同时应用聚合酶链反应—限制性片段长度多态性(PCR-RFLP)方法检测CYP2C19基因多态性,比较基因型在两组间的分布。结果 (1)CLR组与NCLR组相比,体重指数(BMI)>25 kg/m2和接受PCI治疗在两组间有明显的差异(P=0.016<0.05 vs P=0.010<0.05);而胆固醇水平在CLR组明显低于NCLR组(P=0.016<0.05)。(2)在CLR组与NCLR组中,细胞色素CYP450酶中CYP2C19*2携带基因型和等位基因频率的分布在两组间有明显差异(P=0.003 vs P=0.006)。(3)通过多因素Logistic回归分析,发现携带CYP2C19*2和体重指数与CLR有相关性。结论本研究CLR发生率为37.80%,CYP2C19*2突变基因是导致患者服用氯吡格雷后出现低反应的主要危险因素。更多还原

【Abstract】 Objective Explore the CYP450 enzyme CYP2C19 gene polymorphism and coronary heart disease in patients taking clopidogrel correlation between low response.Methods Selection in March 2013 to January 2014 in cardiology,hospital treatment of 82 patients with coronary heart disease,including acute coronary syndrome and elective patients with carotid stenting,300 mg loading dose of clopidogrel to,after the 75 mg/d maintenance treatment.According to the platelet inhibition rate into low clopidogrel response groups(CLR)31 cases and normal response to clopidogrel group(NCLR),51 cases.At the same time,application of polymerase chain reaction-restriction fragment length polymorphism(PCR-RFLP)method to detect CYP2C19 gene polymorphisms,compare the genotype distribution between the two groups.Results(1)The CLR group compared with the NCLR group,body mass index(BMI)>25 kg/m2 and PCI therapy has obvious differences between the two groups(P=0.016<0.05 vs P=0.010<0.05);And cholesterol levels in the CLR significantly lower than the NCLR group(P=0.016<0.05).(2)In the group of the CLR and the NCLR,cytochrome CYP2C19*2 CYP450 enzyme to carry the distribution of genotype and allele frequency between the two groups have significant difference(P=0.003 vs P=0.006).(3)Through the multi-factor Logistic regression analysis,found that carry CYP2C19*2 and body mass index correlation with the CLR.Conclusion CLR incidence was 37.80%,this study is CYP2C19*2 mutations lead to low reaction after taking clopidogrel in patients with major risk factors.更多还原