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目的探讨血小板膜受体P2Y12基因多态性(C34T和G52T)对冠心病患者经皮冠状动脉介入治疗(PCI)术后服用氯吡格雷临床预后的影响。方法入选2008年11月至2009年11月收住我院拟行PCI的冠心病患者268例,正规服用氯吡格雷12个月。采用MassARRAY时间飞行质谱及TaqManAssay检测入选患者血小板受体P2Y12基因C34T和G52T两个位点,按基因型对患者进行分组,观察术后1年间死亡,非致死性心肌梗死、急诊血运重建、支架内血栓形成和心绞痛复发等严重不良心血管事件的发生情况。结果入选病例按G52T位点基因型分为H1/H1型(n=195)和H2携带者(H1/H2和H2/H2,n=73)两组,H1/H1组双支病变比例高于H2携带者组(P约0.05),两组患者其余临床基本资料均一致,无显著性差异(P跃0.05)。PCI术后1年随访期间,两组患者死亡、非致死性心肌梗死、急诊血运重建术等联合终点事件发生率,H2携带者明显高于H1/H1组,差异有统计学意义(12.3%vs援5.1%,P约0.05)。一年累计生存率H2携带者要低于H1/H1组(HR=2.543,95%CI:1.033～6.259,P=0.042)。两组患者急性心肌梗死、支架内血栓形成、急诊血运重建术和死亡的发生率没有明显统计学差异(P跃0.05),但H2携带者心绞痛复发率高于H1/H1组,有统计学差异(P约0.05)。入选病例按C34T位点基因型分为CC型(n=174)和CT/TT型(n=94)两组,两组患者的临床基本资料均匹配(P跃0.05)。PCI术后1年随访期间,两组患者联合终点事件发生率和一年累计生存率均无统计学差异(P跃0.05)。结论血小板膜受体P2Y12基因H2携带者可能是中国冠心病患者介入治疗后服用氯吡格雷临床预后的主要影响因素之一,而C34T位点多态性和介入治疗后服用氯吡格雷临床预后无明显相关性。
Objective To investigate the influence of platelet membrane receptor P2Y12 gene polymorphism (C34T and G52T) on clinical prognosis of patients with coronary heart disease undergoing percutaneous coronary intervention (PCI) after taking clopidogrel. Methods Selected from November 2008 to November 2009 admitted to our hospital for PCI of 268 patients with coronary heart disease, regular use of clopidogrel for 12 months. The patients were divided into two groups according to genotypes, including Massonray time-of-flight mass spectrometry and TaqManAssay test. The patients were divided into two groups according to the genotypes of P2Y12 gene C34T and G52T. The deaths, non-fatal myocardial infarction, emergency revascularization, Thrombosis and angina recurrence and other serious adverse cardiovascular events. Results The cases of G52T genotype were divided into two groups: H1 / H1 (n = 195) and H2 (H1 / H2 and H2 / H2, n = 73) H2 carrier group (P about 0.05), the rest of the clinical data of the two groups were the same, no significant difference (P value 0.05). The incidence of deaths, non-fatal myocardial infarction and emergency revascularization in the two groups were significantly higher than those in H1 / H1 at 1-year follow-up after PCI. The difference was statistically significant (12.3% vs aid 5.1%, P about 0.05). One year cumulative survival rate was lower in H2 carriers than H1 / H1 patients (HR = 2.543, 95% CI: 1.033-6.259, P = 0.042). There was no significant difference in the incidence of acute myocardial infarction, stent thrombosis, emergency revascularization and death between the two groups (p = 0.05), but the recurrence rate of angina was higher in H1 carriers than in H1 carriers Differences (P approximately 0.05). The selected cases were divided into CC (n = 174) and CT / TT (n = 94) genotypes according to C34T genotype. The clinical data of the two groups matched (P 0.05). During 1-year follow-up after PCI, there was no significant difference in the incidence of combined end point events and one-year cumulative survival between the two groups (p = 0.05). Conclusion The P2Y12 H2 receptor of platelet membrane receptor may be one of the main factors affecting the clinical prognosis of patients with coronary heart disease after PCI in China. However, the C34T polymorphism and clinical follow-up after taking clopidogrel Clearly relevant.