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目的探讨中国西北地区汉族部分冠心病患者CYP2C19基因型分布特点,依据基因检测指导PCI术后氯吡格雷抗血小板治疗。方法 1入选2013年1月~7月在西京医院心内科诊断冠心病患者且行基因型检测共2 117例,根据不同等位基因功能缺失分为快代谢基因型(*1/*1);中间代谢型CYP2C19(*1/*2)、(*1/*3);慢代谢型CYP2C19(*2/*2)、(*2/*3)、(*3/*3);2选择上述临床资料完整的急性冠脉综合征(ACS)患者共864例,于术后1,3,6,9和12个月随访两组间主要不良心血管事件(MACE)发生情况。结果 1检测入选的2 117例患者基因型结果显示,快代谢型885例,发生率41.80%,中间代谢型971例,发生率45.86%,慢代谢型261例,发生率12.32%;对入组患者一般临床资料统计分析,各组基因型在性别、不同地区、不同年龄分布的比较均存在差异,具有统计学意义。2快代谢型(正常代谢组)患者346例,中间代谢和慢代谢型(弱代谢组)患者461例,记录随访结果两组间MACE发生率比为〔7.8%(27/346)vs.5.4%(25/461)〕,两组间无统计学差异。结论 1入选患者基因型突变以*1/*2为主,各组在性别、地区、年龄组分布的比较均存在差异;2按患者CYP2C19基因型调整氯吡格雷用量进行抗血小板治疗是有效的。
Objective To investigate the distribution of CYP2C19 genotypes in Han patients with CHD in northwestern China. According to the detection of clopidogrel antiplatelet therapy after PCI. Method 1 From January to July 2013, a total of 2 117 patients with coronary heart disease diagnosed by Xikuang Hospital from January 2013 to July were genotyped and divided into fast metabolic genotypes (* 1 / * 1) according to the different allelic loss. In the middle Metabolism of CYP2C19 (* 1 / * 2), (* 1 / * 3); Slow metabolism of CYP2C19 (* 2 / * 2), (* 2 / * 3), (* 3 / * 3) A total of 864 patients with clinically complete acute coronary syndrome (ACS) were followed up for major adverse cardiovascular events (MACE) at 1, 3, 6, 9 and 12 months after surgery. Results1 The genotypes of 2 117 patients were detected. Among the 885 patients, the rate of fast metabolism was 81.80%, the rate of intermediate metabolism was 971, the rate of 45.86% and the rate of slow metabolism of 261 (12.32%). Statistical analysis of the general clinical data of patients, genotypes in each group in gender, different regions, different age distribution differences are statistically significant. There were 346 patients with fast metabolism type (normal metabolism group), 461 patients with intermediate metabolic rate and slow metabolism type (weak metabolism group), and the follow-up results showed that the incidence of MACE was 7.8% (27/346) vs.5.4 % (25/461)〕, no significant difference between the two groups. Conclusions1 The genotypes of the selected patients are predominantly * 1 / * 2, and there are differences in the distribution of genotypes, regions and age groups; 2 The antiplatelet therapy is effective in adjusting the dosage of clopidogrel according to CYP2C19 genotype .