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目的探讨中国中部地区汉族急性冠状动脉综合征(ACS)患者CYP2C19基因多态性的分布特点,观察不同基因型患者在经皮冠状动脉介入术(PCI)后应用氯吡格雷抗血小板治疗的效果,并分析CYP2C19基因检测在PCI术后患者治疗者中的价值。方法纳入258例接受PCI的ACS患者,对所有患者进行CYP2C19基因型检测。依据CYP2C19基因检测结果,将患者分为快代谢组、中等代谢组和慢代谢组,并于服药后1 h、24 h及7 d后抽血,采用血栓弹力图检测血小板聚集抑制率(IPA)。随访3个月,记录三组药物不良反应及主要不良心血管事件(MACE)发生情况。结果快代谢组、中等代谢组和慢代谢组分别有108例(41.9%)、117例(45.3%)和33例(12.8%)患者,服药后24 h和7 d时,慢代谢组IPA均显著低于快代谢和中等代谢组(P<0.05);慢代谢组药物不良反应及MACE事件发生率高于其他两组,但无显著差异(P>0.05)。结论携带CYP2C19慢代谢基因型患者常规应用氯吡格雷抗血小板治疗作用减弱,CYP2C19基因检测对ACS患者PCI术后抗血小板治疗具有一定指导价值。
Objective To investigate the distribution of CYP2C19 polymorphism in Chinese Han patients with acute coronary syndrome (ACS) in central China and to evaluate the effect of clopidogrel antiplatelet therapy in patients with different genotypes after percutaneous coronary intervention (PCI) And analyze the value of CYP2C19 gene detection in the treatment of patients after PCI. Methods 258 ACS patients with PCI were enrolled in this study. CYP2C19 genotype was detected in all patients. According to the CYP2C19 gene test results, the patients were divided into fast metabolization group, moderate metabolization group and slow metabolism group. Blood samples were drawn at 1, 24 and 7 d after administration. The inhibition rate of platelet aggregation (IPA) . Followed up for 3 months, recorded three groups of adverse drug reactions and major adverse cardiovascular events (MACE) occurred. Results In the fast metabolization group, middle metabolization group and slow metabolization group, there were 108 cases (41.9%), 117 cases (45.3%) and 33 cases (12.8% (P <0.05); adverse drug reactions and MACE events in the slow metabolism group were higher than those in the other two groups (P> 0.05). Conclusion The CYP2C19 genotypes with conventional CYP2C19 antiplatelet therapy has weakened effect, CYP2C19 gene detection of ACS patients with antiplatelet therapy has some guiding value.