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目的:探讨皖北汉族急性冠状动脉综合征(ACS)患者血浆细胞色素P4502C19(CYP2C19)基因多态性分布特征及其与氯吡格雷抵抗(CR)的关系,并评价其对接受经皮冠状动脉介入治疗(PCI)患者近期预后的影响。方法:入选298例住院并接受阿司匹林和氯吡格雷双联抗血小板治疗的皖北汉族ACS患者。采用基因芯片技术和荧光定量PCR检测每位患者CYP2C19基因的多态性,根据结果分为快代谢型(CYP2C19*1/*1)、中等代谢型(CYP2C19*1/*2,CYP2C19*1/*3)和慢代谢型(CYP2C19*2/*2,CYP2C19*2/*3,CYP2C19*3/*3)3组。采用光学比浊法检测每位患者服用氯吡格雷前和用药后7d的血小板聚集率(PAR),以用药前后差值≤10%定义为CR。所有患者均行PCI,计算血管病变支数和Gensini评分。对患者住院期间严密观察,出院后通过电话或门诊随访≥3个月。结果:慢代谢型组较中等代谢型组,中等代谢型组较快代谢型组发生CR的比例均增高(均P<0.05)。3组冠状动脉病变支数和Gensini评分差异均无统计学意义。多因素Logistic回归分析显示,携带CYP2C19突变基因是ACS患者发生CR的独立预测因子(OR:2.122,P<0.01)。随访3个月以上,慢代谢型组和中等代谢型组较快代谢型组有更高的心血管事件发生率(P<0.05)。结论:皖北汉族ACS患者血浆CYP2C19基因多态性与CR的发生存在相关性,且基因突变增加了患者PCI术后心血管事件发生的风险,影响临床预后。
Objective: To investigate the distribution of plasma cytochrome P4502C19 (CYP2C19) polymorphism and its relationship with clopidogrel resistance (CR) in patients with acute coronary syndrome (ACS) in North Anhui. The Impact of Interventional Therapy (PCI) on the Recent Prognosis. Methods: A total of 298 Han patients with ACS in our hospital were enrolled from 298 hospitalized patients who received dual antiplatelet therapy with aspirin and clopidogrel. The CYP2C19 gene polymorphisms in each patient were detected by gene chip technique and real-time PCR. According to the results, the CYP2C19 gene polymorphism was classified into two groups: CYP2C19 * 1 / * 1, CYP2C19 * 1 / * 2, CYP2C19 * 1 / * 3) and slow metabolism (CYP2C19 * 2 / * 2, CYP2C19 * 2 / * 3, CYP2C19 * 3 / * 3) The turbidimetric method was used to detect the platelet aggregation rate (PAR) of each patient before and after taking clopidogrel for 7 days. The difference was defined as CR before and after treatment. All patients underwent PCI, calculate the number of vascular lesions and Gensini score. Close observation of patients during hospitalization, after discharge by telephone or outpatient visits ≥ 3 months. Results: The proportion of CR in the slow metabolizing group was higher than that in the middle metabolizing group and the middle metabolizing group (P <0.05). Three groups of coronary artery lesions and Gensini score differences were not statistically significant. Multivariate logistic regression analysis showed that carrying CYP2C19 mutation was an independent predictor of CR in patients with ACS (OR: 2.122, P <0.01). The follow-up of more than 3 months, the slow metabolic group and the metabolic group faster metabolism group had a higher incidence of cardiovascular events (P <0.05). Conclusion: There is a correlation between plasma CYP2C19 gene polymorphism and the incidence of CR in Han patients with ACS in North Anhui Province. The mutation of gene may increase the risk of cardiovascular events after PCI and influence the clinical prognosis.