【摘要】 目的初步探索氯吡格雷抵抗性与急性心肌梗死(acute myocardial infarction,AMI)患者经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗或经皮腔内冠状动脉成形术(percutaneous transluminal coronaryangioplasty,PTCA)后主要心血管事件(major adverse cardiovasular events,MACEs)发生率的关系。方法前瞻、连续入组2015年5月至2015年8月在广东省人民医院行PCI治疗或PTCA的AMI患者89例。MACEs定义为心源性死亡、非致死性心肌梗死、脑卒中、血运重建、急性心力衰竭。通过VerifyNow-P2Y12系统检测血小板功能,根据血小板反应单位(platelet reaction unit,PRU)(P2Y12反应单位,代表血小板残余活性)分为两组:氯吡格雷反应正常组(PRU<208)35例和氯吡格雷抵抗组(PRU≥208)54例。收集患者临床和6个月随访的资料,及部分患者CYP2C19基因型的资料,比较两组基线资料和半年MACEs发生率。结果 CYP2C19基因型检测提示中、快代谢型高达56.2%。正常组慢代谢型、中代谢型、快代谢型、未检测比例分比为3(5.5%)、13(24.1%)、19(35.2%)、19(35.2%),抵抗组为4(11.4%)、11(31.4%)、7(20.0%)、13(37.2%),两组比较差异无统计学意义(P>0.05)。与正常组比较,抵抗组MACEs发生率有增高趋势,但两组比较差异无统计学意义(18.2%vs.7.5%,P=0.173);抵抗组急性心力衰竭的发生率比正常组高,差异有统计学意义(12.1%vs.0,P=0.019);两组心源性死亡、非致死性心肌梗死、卒中、血运重建发生率比较,差异无统计学意义(P>0.05)。结论 PCI治疗或PTCA术后双联抗血小板治疗的AMI患者较高比例CYP2C19基因型为中、快代谢型;氯吡格雷抵抗患者的MACEs发生有增加趋势。更多还原

【Abstract】 Objectives To explore the relationship between major adverse cardiovasular events(MACEs)and clopidogrel resistance detected by VerifyNow-P2Y12 in patients with acute myocardial infarction(AMI). Methods The 89 patients with AMI and undergoing percutaneous coronary intervention(PCI)or percutaneous transluminal coronary angioplasty(PTCA)were continuously enrolled from May to August 2015 in Guangdong General Hospital,prospectively. MACEs was defined as cardiovascular death,non-fatal myocardial infarction,stroke,revascularization and acute heart failure. Platelet reaction unit(PRU)was detected by VerifyNow-P2Y12. Then patients were divided into normal group(PRU<208)[35(39.3%)patients]and resistant group(PRU≥208)[54(61.7%)patients]. Baseline clinical and 6-month follow-up data were obtained,while the data of CYP2C19 gene was obtained in part of patients. Baseline,genetic data and 6-month MACEs were compared between the two groups. Results Including those not detected,it was detected that intermediate metabolizer and extensive metabolizer of CYP2C19 gene was 56.2% in study population.The proportion of extensive,intermediate,slow metabolizer and un-detected was 3(5.5%),13(24.1%),19(35.2%),19(35.2%)in normal group,while 4(11.4%),11(31.4%),7(20.0%),13(37.2%)in resistant group(P=0.386).Compared to normal group,there was a increasing trend in resistance group in incidence of MACEs(18.2% vs. 7.5%,P=0.173). Besides,acute heart failure occurred in 4(4.5%)patients,including 4(12.1%)in resistance group,and 0 in normal group(P=0.019),respectively. There were no significant differences of incidences of cardiac death,nonfatal myocardial infarction,stroke,revascularization between the two groups(P>0.05). Conclusions The high proportion of AMI patients following PCI and dual-antiplatelet therapy carry extensive and intermediate metabolizer of CYP2C19 gene. Comparing to normal group,there is a increasing trend of incidence of MACEs in resistance group.更多还原