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基于CYP2C19基因检测指导下的氯吡格雷和换用替格瑞洛个体化用药分析

Based on CYP2C19 Genotype of Clopidogrel and Ticagrelor Treatment of Acute Coronary Syndromes Individualized Drug Analysis
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摘要 目的探讨CPY2C19基因多态性对氯吡格雷及换用替格瑞洛治疗急性冠脉综合征不良事件的影响,为临床个体化用药提供参考。方法选择2015年03月~2018年03月入住我院心血管内科的急性冠脉综合征患者1 086例为研究对象,根据患者是否同意做CPY2C19基因检测进行分组,A组为未进行基因检测,常规使用氯吡格雷+阿司匹林,B、C、D组患者采用实时荧光定量PCR方法进行CYP2C19基因型检测,B组(超快代谢型和快代谢型)同A组常规用药,C组(中间代谢型),采用双倍氯吡格雷+阿司匹林方案,D组(慢代谢型),采用双倍氯吡格雷+阿司匹林(D1组)或替格瑞洛+阿司匹林(D2组)方案,比较4组间患者主要不良事件和次要不良事件的发生情况。结果 A、B、C和D 4组间主要不良事件发生率及支架内血栓发生率有显著差异(P <0. 05),A组支架内血栓发生率显著高于B和C组(P <0. 05)。次要不良事件中靶血管重建和心源性再入院发生率在4组间存在显著差异(P均<0. 05),A组靶血管重建显著高于B和C组(P <0. 01),A组心源性再入院发生率显著高于B、C和D组(P <0. 01)。C组与D1组相比,D1组次要不良事件发生率、支架内血栓、靶血管重建和心源性再入院发生率均显著高于C组(P均<0. 05)。D2组与D1组相比,D1组心源性再入院发生率显著高于D2组(P <0. 05),但D2组出血事件偏高。结论经CPY2C19基因检测对急性冠脉综合征患者进行个体化给药,显著降低不良事件发生率,有极大的指导意义,同时要注意超快代谢型出血事件的发生。 OBJECTIVE To investigate the adverse events of CYP2 C19 gene polymorphism on clopidogrel and ticagrelor in the treatment of acute coronary syndrome and provide reference for clinical individualized medication. METHODS The total of 1 086 patients with acute coronary syndrome were selected as the subjects in the cardiovascular department of Zhengzhou Central Hospital Affiliated to Zhengzhou University from March 2015 to March 2018. The patients were grouped according to whether they agreed to do the CPY2 C19 gene test or not. The patients who didn’t carry out CYP2 C19 gene testing were given routine dosage( Group A,75 mg clopidogrel and 100 mg aspirin). The CYP2 C19 genotype was detected by real-time fluorescence quantitative PCR for patients in group B,group C and group D. According to the genotype,patients were divided into three groups: group B( super fast metabolism and fast metabolism,75 mg clopidogrel and 100 mg aspirin),group C( intermediate metabolism,150 mg clopidogrel dosage and 100 mg aspirin),group D( slow metabolism,150 mg clopidogrel dosage and 100 mg aspirin or 180 mg ticagrelor and 100 mg aspirin). The incidence of major adverse events and minor adverse events were compared among the four groups. RESULTS There was significant differences in the incidence of major adverse events and stent thrombosis among group A,group B,group C and group D( P < 0. 05). The incidence of stent thrombosis in group A was significantly higher than that in group B and group C,respectively( all P < 0. 05). There were significant differences in the incidence of target vessel reconstruction and cardiogenic readmission among the four groups( all P < 0. 05).The target vessel reconstruction in group A was significantly higher than that in group B and group C( P < 0. 01). The cardiogenic readmission in group A was significantly higher than that in group B,group C and group D( all P < 0. 01). Compared with group D1,the incidence of secondary adverse events,stent thrombosis,target vessel reconstruction and cardiogenic readmissio
作者 李敏 周丽娟 詹峰 尹宁伟 LI Min;ZHOU Li-juan;ZHAN Feng;YIN Ning-wei(Zhengzhou Central Hospital Affiliated to Zhenghzou University, Zhengzhou 450007, China)
出处 《中国药学杂志》 CAS CSCD 北大核心 2019年第9期753-760,共8页 Chinese Pharmaceutical Journal
基金 河南省教育厅重点项目资助(16A310033)。
关键词 CYP2C19 氯吡格雷 替格瑞洛 个体化用药 不良心血管事件 CYP2C19 clopidogrel ticagrelor personalized medication adverse cardiac event
作者简介 李敏,女,副主任药师,研究方向:药物基因组学;通讯作者:周丽娟,女,副主任药师,研究方向:药物基因组学和药物分析学,Tel:(0371)67690341,E-mail:zhou750423@126.com.
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