南方医科大学学报

南方医科大学学报 ›› 2020, Vol. 40 ›› Issue (02): 274-278.doi: 10.12122/j.issn.1673-4254.2020.02.21

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细胞色素P4502C19基因检测对稳定性心绞痛患者左主干介入术后抗血小板治疗的指导价值

郑小芳，吴黎明   

  • 出版日期:2020-03-14 发布日期:2020-02-20
  • 基金资助:

The value of cytochrome P4502C19 gene assay for anti-platelet therapy after PCI in stable angina patients with left main coronary artery lesions

  

  • Online:2020-03-14 Published:2020-02-20

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摘要： 目的 对复杂冠状动脉左主干病变且细胞色素P4502C19（CYP2C19）基因为中间代谢的稳定性心绞痛患者，评价其经皮冠状动脉介入治疗（PCI）术后给予不同抗血小板治疗方案的有效性及安全性。方法 回顾性分析2015年2月~2017年2月福建医科大学附属协和医院心内科收治的行择期左主干PCI术且CYP2C19基因型检测为中间代谢型的稳定性心绞痛患者247例,根据服用药物分为氯吡格雷组152例（阿司匹林+氯吡格雷组），替格瑞洛组95例（阿司匹林+替格瑞洛）。2组术前均给予阿司匹林+氯吡格雷各300 mg口服；替格瑞洛组术后给予替格瑞洛维持剂量90 mg口服，2次/d；氯吡格雷组术后给予氯吡格雷维持剂量75 mg口服，1次/d；2组术后阿司匹林维持剂量100 mg口服，1次/d。观察术后12个月内主要不良心血管事件（MACE）发生情况。结果 术后12个月时，替格瑞洛组MACE发生率明显低于氯吡格雷组，差异有统计学意义（2.1% vs 15.1%，P=0.001）；2组非血运重建性靶血管再狭窄、再发非心肌梗死性心绞痛、再发心肌梗死、靶血管再次血运重建比较，差异无统计学意义（P>0.05）。两组出血发生率无明显差异（P>0.05）。结论 对于复杂冠状动脉左主干病变且CYP2C19基因为中间代谢的稳定性心绞 痛患者，PCI术后使用阿司匹林联合替格瑞洛抗血小板治疗获益明显，较阿司匹林联合氯吡格雷能进一步降低MACE发生率，并不增加出血风险。

Abstract: Objective To evaluate the efficacy and safety of different antiplatelet therapies for stable angina patients with complicated left main coronary artery lesions and intermediate metabolizer Cytochrome P450 2C19 gene (CYP2C19) undergoing PCI. Methods A total of 247 patients diagnosed with stable angina in cardiology department of Fujian union hospital from February 2015 to February 2017 were retrospectively analyzed, among them,the elective PCI were performed on the left main coronary artery and the CYP2C19 gene poly-morphism were intermediate metabolize, they were divided into ticagrelor treatment group（aspirin combined with ticagrelor, n=95）and clopidogrel treatment group(aspirin combined with clopidogrel, n=152) according to the different antiplatelet treatment programs. Both groups were given aspirin 300 mg and clopidogrel 300 mg orally before PCI; the ticagrelor group were given the maintenance dose of ticagrelor (90 mg orally, twice a day) after PCI, while those in clopidogrel group were clopidogrel 75 mg orally (once a day) after PCI; both groups were given the maintenance dose of aspirin (100 mg orally, once a day)after PCI. The major adverse cardiovascular events (MACE) were observed within 12 months after PCI. Results At 12 months after PCI, the incidence of MACE in the ticagrelor treatment group was significantly lower than that in the clopidogrel treatment group, the difference was statistically significant (2.1% vs 15.1%， P=0.001).There were no significant differences between the two groups in the restenosis rates of non- revascularized target vessel, recurrent rates of angina pectoris(but not myocardial infarction), recurrent rates of myocardial infarction, and revascularization rates of target vessel (P>0.05). There were also no significant differences between the two groups in bleeding. Conclusion For stable angina patients with complicated left main coronary artery lesions and intermediate metabolizer CYP2C19 gene,aspirin combined with ticagrelor antiplatelet therapy after PCI is effective, the effect of ticagrelor is better than clopidogrel on MACE, and ticagrelor does not seem to increase the risk of bleeding.