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目的:评价CYP2C19基因型功能缺失患者介入术后不同抗血小板治疗方案的安全性及有效性。方法:纳入择期冠脉支架植入术后行CYP2C19基因型检测的患者,按其表型分为快代谢组,中代谢组及慢代谢组,将中代谢组随机分为氯吡格雷双倍剂量组和氯吡格雷常规剂量联用西洛他唑组,慢代谢组随机分为替格瑞洛组和氯吡格雷常规剂量联用西洛他唑组,另设快代谢氯吡格雷常规剂量组为对照组,连续用药6个月,随访其临床事件。结果:所有患者中CYP2C19基因快、中、慢代谢型的比例分别为25%,60%,15%;中代谢型患者使用氯吡格雷双倍剂量方案或氯吡格雷常规剂量联用西洛他唑方案、慢代谢患者使用替格瑞洛方案,可取得与快代谢型患者常规剂量氯吡格雷方案相似的疗效,但慢代谢患者使用氯吡格雷常规剂量联用西洛他唑预防心脏缺血的获益不佳,劣于替格瑞洛方案。结论:择期冠脉支架植入术后的中代谢患者在服用阿司匹林的基础上,采用氯吡格雷双倍剂量或氯吡格雷常规剂量联用西洛他唑的方案可能有益;慢代谢型患者建议使用替格瑞洛。
Objective: To evaluate the safety and efficacy of different antiplatelet regimens after interventional therapy in CYP2C19-deficient patients. Methods: The patients with CYP2C19 genotype detected after elective coronary stent implantation were divided into fast metabolization group, moderate metabolization group and slow metabolism group according to their phenotypes. The middle metabolization group was randomly divided into double dose of clopidogrel Group and clopidogrel conventional dose combination cilostazol group, slow metabolism group were randomly divided into ticagrelor group and conventional dose of clopidogrel combined with cilostazol group, another set of fast metabolism clopidogrel conventional dose group For the control group, continuous medication for 6 months, follow-up of their clinical events. Results: CYP2C19 gene in all patients were 25%, 60% and 15% of the fast, moderate and chronic metabolites respectively. In the middle metabolized patients, the double dose of clopidogrel or conventional dose of clopidogrel combined with cilostazol The azole regimen and the slow metabolizing regimen of ticlopirod can achieve similar efficacy as the regular dose clopidogrel regimen in patients with metabolic syndrome, but slow metabolism patients are treated with conventional doses of clopidogrel in combination with cilostazol for the prevention of cardiac ischemia Poor benefit, worse than ticagrelor program. CONCLUSIONS: In patients with moderate metabolism following elective coronary stenting, aspirin may be beneficial in patients receiving double-dose clopidogrel or conventional doses of clopidogrel in combination with cilostazol; Ticagrelor is used.