CAJ | 학술논문

观察CYP2C19基因多态性对服用氯吡格雷的冠心病患者临床预后的影响。方法选取2012年5月至2013年3月经皮冠状动脉介入并植入药物洗脱支架的急性冠状动脉综合征患者122例，术后均服用75 mg氯吡格雷（波立维）维持治疗；检测CYP2C19倡1、倡2、倡3基因型（其中CYP2C19倡1为野生型基因，CYP2C 19倡2、倡3为功能缺失型基因），并对患者进行6个月的随访。结果根据基因型检测结果分为快代谢组（CYP2C19倡1/倡1，EM ）、中间代谢组（CYP2C19倡1/倡2、倡1/倡3，IM ）及慢代谢组（CYP2C19倡2/倡2、倡3/倡3， PM）。随访结果发现，IM组及PM组发生主要不良心脏事件（MACE）的概率要高于EM 组患者，差异有统计学意义（P＜0．05）；Logistic回归分析MACE的相关因素发现，糖尿病及CYP2C19基因型别与发生MACE有相关性，差异有统计学意义（P＜0．05）。结论 CYP2C19基因多态性与服用氯吡格雷的冠心病患者预后相关，至少携带一种功能缺失型基因的患者发生心肌梗死、心源性死亡、支架内血栓的发生率要高于野生型CYP2C19基因型患者。
관찰CYP2C19기인다태성대복용록필격뢰적관심병환자림상예후적영향。방법선취2012년5월지2013년3월경피관상동맥개입병식입약물세탈지가적급성관상동맥종합정환자122례，술후균복용75 mg록필격뢰（파립유）유지치료；검측CYP2C19창1、창2、창3기인형（기중CYP2C19창1위야생형기인，CYP2C 19창2、창3위공능결실형기인），병대환자진행6개월적수방。결과근거기인형검측결과분위쾌대사조（CYP2C19창1/창1，EM ）、중간대사조（CYP2C19창1/창2、창1/창3，IM ）급만대사조（CYP2C19창2/창2、창3/창3， PM）。수방결과발현，IM조급PM조발생주요불양심장사건（MACE）적개솔요고우EM 조환자，차이유통계학의의（P＜0．05）；Logistic회귀분석MACE적상관인소발현，당뇨병급CYP2C19기인형별여발생MACE유상관성，차이유통계학의의（P＜0．05）。결론 CYP2C19기인다태성여복용록필격뢰적관심병환자예후상관，지소휴대일충공능결실형기인적환자발생심기경사、심원성사망、지가내혈전적발생솔요고우야생형CYP2C19기인형환자。
Objective To observe the influences of CYP2C19 polymorphism on prognosis of coronary heart disease patients under treatment of clopidogrel (plavix) .Methods A total of 122 patients with coronary heart disease were enrolled from May 2012 to March 2013 .All of the patients undertook percutaneous coronary intervention (PCI) and received a maintenance treatment of 75 mg clopidogrel orally .CYP2C19 *1 ,*2 ,*3 genotypes were detected . All patients were followed up for 6 months .Results According to the results of genetic testing ,all patients were di‐vided into extensive metabolism (EM ,CYP2C19 * 1/* 1) group ,intermediate metabolism (IM ,CYP2C19 * 1/*2 ,*1/*3) group and poor metabolism (PM ,CYP2C19*2/*2 ,*3/*3) group .During the follow‐up of 6 months , the incidence rates of major adverse cardiac events (MACE) in IM group and PM group were higher than EM group (P<0 .05) .Logistic aggression analysis of MACE related factors indicated that diabetes mellitus and CYP 2C19 poly‐morphism were both significant factors (P< 0 .05) .Conclusion CYP2C19 polymorphism could be a predictor of prognosis in patients with coronary heart disease .The loss of function gene could increase the possibility of myocardi‐al infarction ,cardiac death and stent thrombosis ,compared to wild type patients .