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CYP2C19基因指导冠心病患者经皮冠状动脉介入术后抗血小板药合理应用

张红楠,  王强,  朱晓红,  郎轶咏

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文章导航 > 药学实践与服务  > 2018 >  36(6): 518-521
张红楠, 王强, 朱晓红, 郎轶咏. CYP2C19基因指导冠心病患者经皮冠状动脉介入术后抗血小板药合理应用[J]. 药学实践与服务, 2018, 36(6): 518-521. doi: 10.3969/j.issn.1006-0111.2018.06.009
引用本文: 张红楠, 王强, 朱晓红, 郎轶咏. CYP2C19基因指导冠心病患者经皮冠状动脉介入术后抗血小板药合理应用[J]. 药学实践与服务, 2018, 36(6): 518-521. doi: 10.3969/j.issn.1006-0111.2018.06.009
shu
ZHANG Hongnan, WANG Qiang, ZHU Xiaohong, LANG Yiyong. The rational use of antiplatelet drugs guided by CYP2C19 genotyping in patients with coronary heart disease after PCI[J]. Journal of Pharmaceutical Practice and Service, 2018, 36(6): 518-521. doi: 10.3969/j.issn.1006-0111.2018.06.009
Citation: ZHANG Hongnan, WANG Qiang, ZHU Xiaohong, LANG Yiyong. The rational use of antiplatelet drugs guided by CYP2C19 genotyping in patients with coronary heart disease after PCI[J]. Journal of Pharmaceutical Practice and Service, 2018, 36(6): 518-521. doi: 10.3969/j.issn.1006-0111.2018.06.009
shu

CYP2C19基因指导冠心病患者经皮冠状动脉介入术后抗血小板药合理应用

doi: 10.3969/j.issn.1006-0111.2018.06.009
  • 1.

    大连医科大学, 辽宁 大连 116044;解放军202医院, 辽宁 沈阳 110812

  • 2.

    解放军202医院, 辽宁 沈阳 110812

The rational use of antiplatelet drugs guided by CYP2C19 genotyping in patients with coronary heart disease after PCI

  • 1.

    Dalian Medical University, Dalian 116044, China;No. 202 Hospital of PLA, Shenyang 110812, China

  • 2.

    No. 202 Hospital of PLA, Shenyang 110812, China

  • 摘要: 目的 探索CYP2C19基因指导冠心病患者经皮冠状动脉介入（PCI）术后抗血小板药物的合理使用。 方法 利用医院管理信息系统，收集2015年12月至2016年12月在心内科住院的冠心病患者2 836例，从中选取符合标准的CYP2C19 IM和PM基因型患者480例，根据患者是否根据基因型改变治疗方案，将患者分为常规剂量氯吡格雷组（常规治疗组）、氯吡格雷剂量加倍组和替格瑞洛组，观察各组患者血小板聚集抑制率和1年内主要不良心血管（MACE）及出血事件发生率。 结果 最终入选468例患者，替格瑞洛组和剂量加倍组的血小板聚集抑制率均高于常规治疗组（P<0.05），且替格瑞洛组又明显高于剂量加倍组（P<0.05）。MACE事件发生率方面，各组患者均是再发心肌梗死发生率最高，且替格瑞洛组及剂量加倍组明显低于常规治疗组（P<0.017），其余MACE各事件及出血发生率各组之间无差异性（P>0.017）。 结论 CYP2C19基因指导下冠心病患者PCI术后抗血小板治疗临床效果较好，临床应根据患者基因特点进行个体化合理用药。
    Abstract: Objective To explore the rational use of antiplatelet agents in patients with coronary heart disease after PCI guided by CYP2C19 genotyping. Methods Using the hospital management information system, 2 836 patients with coronary heart disease hospitalized in the Department of Cardiology from December 2015 to December 2016 were collected. Among them, 480 patients with CYP2C19 IM and PM genotypes met the criteria and were selected for the study. Patients were divided into conventional treatment group, double clopidogrel dose group and ticagrelor group based on the treatment plans according to genotype. The inhibition rate of platelet aggregation, major adverse cardiovascular event (MACE) and incidence of bleeding within one year were observed in each group. Results In the finally selected 468 patients, the platelet aggregation inhibition rate in ticagrelor group and the double clopidogrel dose group was higher than the conventional treatment group (P<0.05). The inhibition rate was significantly higher in ticagrelor group than the double clopidogrel dose group (P<0.05). The incidence of recurrent angina was highest in each group as MACE and significantly lower in double clopidogrel dose group and ticagrelor group than that in conventional treatment group(P<0.017). There was no significant difference in each group in terms of other MACE and incidence of bleeding (P>0.017). Conclusion The patients with coronary heart disease exhibited better therapeutic results from antiplatelet treatments guided with CYP2C19 genotyping. Individualized medication regimen should be implemented clinically according to the patient's genetic characteristics.
  • [1] MEHTA SR, YUSUF S, PETERS RJ, et al. Effects of pretreatment with clopidogrel and aspirin followed by long-term therapy in patients undergoing percutaneous coronary intervention:the PCI-CURE study[J]. Lancet, 2001, 358(9281):527-533.
    [2] QURESHI Z, HOBSON AR. Clopidogrel "resistance":where are we now[J]. Cardiovasc Ther, 2013, 31(1):3-11.
    [3] HARMSZE A, VAN WERKUM JW, BOUMAN HJ, et al. Besides CYP2C19*2, the variant allele CYP2C9*3 is associated with higher on-clopidogrel platelet reactivity in patients on dual antiplatelet therapy undergoing elective coronary stent implantation[J]. Pharmacogenetics and Genomics, 2010, 20(1):18-25.
    [4] JAN L. Application of oral antiplatelet therapy in the treatment of coronary heart disease[J]. Chinese Circulation Journal, 2012,27(4):317-318.
    [5] ERLINGE D, JAMES S, DUVVURU S, et al. Clopidogrel metaboliser status based on point-of-care CYP2C19 genetic testing in patients with coronary artery disease[J]. Thromb Haemost, 2014, 111(5):943-950.
    [6] MAO L, JIAN C, CHANGZHI L, et al. Cytochrome CYP2C19 polymorphism and risk of adverse clinical events in clopidogrel-treated patients:a meta-analysis based on 23,035 subjects[J]. Arch Cardiovasc Dis, 2013, 106(10):517-527.
    [7] SCOTT SA, SANGKUHL K, GARDNER EE, et al. Clinical pharmacogenetics implementation consortium guidelines for cytochrome P450-2C19(CYP2C19) genotype and clopidogrel therapy[J]. Clinical Pharmacology & Therapeutics, 2011, 90(2):328-332.
    [8] WIVIOTT SD, BRAUNWALD E, McCABE CH, et al. Prasugrel versus clopidogrel in patients with acute coronary syndromes[J]. N Engl J Med, 2007, 357(20):2001-2015.
    [9] DOBESH PP, OESTREICH JH. Ticagrelor:pharmacokinetics, pharmacodynamics, clinical efficacy, and safety[J]. Pharmacotherapy, 2014, 34(10):1077-1090.
    [10] XIONG R, LIU W, CHEN L, et al. A randomized controlled trial to assess the efficacy and safety of doubling dose clopidogrel versus ticagrelor for the treatment of acute coronary syndrome in patients with CYP2C19*2 homozygotes[J]. Int J Clin Exp Med, 2015, 8(8):13310-13316.
    [11] CHEN S, ZHANG Y, WANG L, et al. Effects of dual-dose clopidogrel, clopidogrel combined with tongxinluo capsule, and ticagrelor on patients with coronary heart disease and CYP2C19*2 gene mutation after percutaneous coronary interventions (PCI)[J]. Med Sci Monit, 2017, 23:3824-3830.
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  • 收稿日期:  2018-03-21
  • 修回日期:  2018-07-25

CYP2C19基因指导冠心病患者经皮冠状动脉介入术后抗血小板药合理应用

doi: 10.3969/j.issn.1006-0111.2018.06.009
  • 1. 大连医科大学, 辽宁 大连 116044;解放军202医院, 辽宁 沈阳 110812
  • 2. 解放军202医院, 辽宁 沈阳 110812
  • 收稿日期: 2018-03-21
  • 修回日期: 2018-07-25

摘要: 目的 探索CYP2C19基因指导冠心病患者经皮冠状动脉介入（PCI）术后抗血小板药物的合理使用。 方法 利用医院管理信息系统，收集2015年12月至2016年12月在心内科住院的冠心病患者2 836例，从中选取符合标准的CYP2C19 IM和PM基因型患者480例，根据患者是否根据基因型改变治疗方案，将患者分为常规剂量氯吡格雷组（常规治疗组）、氯吡格雷剂量加倍组和替格瑞洛组，观察各组患者血小板聚集抑制率和1年内主要不良心血管（MACE）及出血事件发生率。 结果 最终入选468例患者，替格瑞洛组和剂量加倍组的血小板聚集抑制率均高于常规治疗组（P<0.05），且替格瑞洛组又明显高于剂量加倍组（P<0.05）。MACE事件发生率方面，各组患者均是再发心肌梗死发生率最高，且替格瑞洛组及剂量加倍组明显低于常规治疗组（P<0.017），其余MACE各事件及出血发生率各组之间无差异性（P>0.017）。 结论 CYP2C19基因指导下冠心病患者PCI术后抗血小板治疗临床效果较好，临床应根据患者基因特点进行个体化合理用药。

English Abstract

张红楠, 王强, 朱晓红, 郎轶咏. CYP2C19基因指导冠心病患者经皮冠状动脉介入术后抗血小板药合理应用[J]. 药学实践与服务, 2018, 36(6): 518-521. doi: 10.3969/j.issn.1006-0111.2018.06.009
引用本文: 张红楠, 王强, 朱晓红, 郎轶咏. CYP2C19基因指导冠心病患者经皮冠状动脉介入术后抗血小板药合理应用[J]. 药学实践与服务, 2018, 36(6): 518-521. doi: 10.3969/j.issn.1006-0111.2018.06.009
shu
ZHANG Hongnan, WANG Qiang, ZHU Xiaohong, LANG Yiyong. The rational use of antiplatelet drugs guided by CYP2C19 genotyping in patients with coronary heart disease after PCI[J]. Journal of Pharmaceutical Practice and Service, 2018, 36(6): 518-521. doi: 10.3969/j.issn.1006-0111.2018.06.009
Citation: ZHANG Hongnan, WANG Qiang, ZHU Xiaohong, LANG Yiyong. The rational use of antiplatelet drugs guided by CYP2C19 genotyping in patients with coronary heart disease after PCI[J]. Journal of Pharmaceutical Practice and Service, 2018, 36(6): 518-521. doi: 10.3969/j.issn.1006-0111.2018.06.009
shu

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