中华老年多器官疾病杂志
中華老年多器官疾病雜誌
중화노년다기관질병잡지
CHINESE JOURNAL OF MULTIPLE ORGAN DISEASES IN THE ELDERLY
2014年
10期
721-726
,共6页
彭利%张蓝宁%陈曦%王绪云%李晓琪%傅义程%杨洁%张玉霄%陈韵岱%卢才义%尹彤
彭利%張藍寧%陳晞%王緒雲%李曉琪%傅義程%楊潔%張玉霄%陳韻岱%盧纔義%尹彤
팽리%장람저%진희%왕서운%리효기%부의정%양길%장옥소%진운대%로재의%윤동
老年人%经皮冠状动脉介入治疗%氯吡格雷%CYP2C19%血小板反应性%心血管事件
老年人%經皮冠狀動脈介入治療%氯吡格雷%CYP2C19%血小闆反應性%心血管事件
노년인%경피관상동맥개입치료%록필격뢰%CYP2C19%혈소판반응성%심혈관사건
elderly%percutaneous coronary intervention%clopidogrel%CYP2C19%plateletreactivity%cardiovascular events
目的:探讨编码CYP2C19酶的基因(CYP2C19)功能缺失性(LOF)等位基因与老年冠心病患者支架植入术后氯吡格雷抗血小板反应性和临床心血管终点事件的关联性。方法连续募集2011年9月1日至2012年12月1日期间在解放军总医院住院拟行经皮冠状动脉介入术(PCI)、年龄≥65岁的老年冠心病患者,术前给予氯吡格雷负荷剂量(300mg)治疗,手术当日测定血小板聚集率,采用SNaPshot法进行CYP2C19 LOF等位基因型(CYP2C19*2和CYP2C19*3)检测,并记录在院临床资料。所有患者均在PCI术后1年规律服用阿司匹林和氯吡格雷,随访1年内主要心血管缺血和出血事件的发生率。结果在436例符合入选标准的老年冠心病患者中,CYP2C19*2携带者与氯吡格雷负荷剂量治疗后的抗血小板反应性之间存在显著相关性(P=0.001),但在CYP2C19*3携带者中未见上述相关性(P=0.884)。CYP2C19*2和至少一个CYP2C19 LOF携带者1年内心血管终点事件的发生率较非携带者均明显增加(P<0.05)。与非携带者相比,CYP2C19*2携带者因心绞痛再入院的发生率明显增加[校正比值比(OR):1.67,95%可信区间(CI):1.05~2.65,P=0.010]。至少一个CYP2C19 LOF携带者的联合心血管事件(校正OR:1.22,95%CI:1.03~1.98,P=0.049)和因心绞痛再入院(校正OR:1.67,95%CI:1.04~2.68,P=0.032)的发生率较非携带者明显增加。结论 CYP2C19 LOF等位基因与老年冠心病患者PCI术后的氯吡格雷抗血小板反应性密切相关,并可明显削弱PCI术后双联抗血小板的治疗效果,导致PCI术后1年内的心血管终点事件发生风险明显增加。
目的:探討編碼CYP2C19酶的基因(CYP2C19)功能缺失性(LOF)等位基因與老年冠心病患者支架植入術後氯吡格雷抗血小闆反應性和臨床心血管終點事件的關聯性。方法連續募集2011年9月1日至2012年12月1日期間在解放軍總醫院住院擬行經皮冠狀動脈介入術(PCI)、年齡≥65歲的老年冠心病患者,術前給予氯吡格雷負荷劑量(300mg)治療,手術噹日測定血小闆聚集率,採用SNaPshot法進行CYP2C19 LOF等位基因型(CYP2C19*2和CYP2C19*3)檢測,併記錄在院臨床資料。所有患者均在PCI術後1年規律服用阿司匹林和氯吡格雷,隨訪1年內主要心血管缺血和齣血事件的髮生率。結果在436例符閤入選標準的老年冠心病患者中,CYP2C19*2攜帶者與氯吡格雷負荷劑量治療後的抗血小闆反應性之間存在顯著相關性(P=0.001),但在CYP2C19*3攜帶者中未見上述相關性(P=0.884)。CYP2C19*2和至少一箇CYP2C19 LOF攜帶者1年內心血管終點事件的髮生率較非攜帶者均明顯增加(P<0.05)。與非攜帶者相比,CYP2C19*2攜帶者因心絞痛再入院的髮生率明顯增加[校正比值比(OR):1.67,95%可信區間(CI):1.05~2.65,P=0.010]。至少一箇CYP2C19 LOF攜帶者的聯閤心血管事件(校正OR:1.22,95%CI:1.03~1.98,P=0.049)和因心絞痛再入院(校正OR:1.67,95%CI:1.04~2.68,P=0.032)的髮生率較非攜帶者明顯增加。結論 CYP2C19 LOF等位基因與老年冠心病患者PCI術後的氯吡格雷抗血小闆反應性密切相關,併可明顯削弱PCI術後雙聯抗血小闆的治療效果,導緻PCI術後1年內的心血管終點事件髮生風險明顯增加。
목적:탐토편마CYP2C19매적기인(CYP2C19)공능결실성(LOF)등위기인여노년관심병환자지가식입술후록필격뢰항혈소판반응성화림상심혈관종점사건적관련성。방법련속모집2011년9월1일지2012년12월1일기간재해방군총의원주원의행경피관상동맥개입술(PCI)、년령≥65세적노년관심병환자,술전급여록필격뢰부하제량(300mg)치료,수술당일측정혈소판취집솔,채용SNaPshot법진행CYP2C19 LOF등위기인형(CYP2C19*2화CYP2C19*3)검측,병기록재원림상자료。소유환자균재PCI술후1년규률복용아사필림화록필격뢰,수방1년내주요심혈관결혈화출혈사건적발생솔。결과재436례부합입선표준적노년관심병환자중,CYP2C19*2휴대자여록필격뢰부하제량치료후적항혈소판반응성지간존재현저상관성(P=0.001),단재CYP2C19*3휴대자중미견상술상관성(P=0.884)。CYP2C19*2화지소일개CYP2C19 LOF휴대자1년내심혈관종점사건적발생솔교비휴대자균명현증가(P<0.05)。여비휴대자상비,CYP2C19*2휴대자인심교통재입원적발생솔명현증가[교정비치비(OR):1.67,95%가신구간(CI):1.05~2.65,P=0.010]。지소일개CYP2C19 LOF휴대자적연합심혈관사건(교정OR:1.22,95%CI:1.03~1.98,P=0.049)화인심교통재입원(교정OR:1.67,95%CI:1.04~2.68,P=0.032)적발생솔교비휴대자명현증가。결론 CYP2C19 LOF등위기인여노년관심병환자PCI술후적록필격뢰항혈소판반응성밀절상관,병가명현삭약PCI술후쌍련항혈소판적치료효과,도치PCI술후1년내적심혈관종점사건발생풍험명현증가。
ObjectiveTo investigate the relationships between the cytochrome 2C19 gene (CYP2C19) loss-of-function(LOF) allele with clopidogrel platelet reactivity and cardiovascular end point events intheelderly patients with coronary heart disease (CHD) after percutaneous coronary intervention(PCI).MethodsOver-65-year-old consecutiveCHD patients who accepted selective PCIin our department from September 1,2011 to December 1, 2012 were recruited in this study.They were given clopidogrel loadingdose therapy before PCI,andtheir peripheral blood samples were collected on the day of PCI to detect platelet aggregation. The candidategenetic variants, CYP2C19*2and*3LOFalleles,were determined by using SNaPshotassay, and the results were recordedinthe clinical data. All patients receivedmaintenance dose of aspirin andclopidogrelduring 1 year’s follow-up after PCI, andthemajor adverse cardiovascular events were observedin this period.ResultsAtotalof436 elderly CHD patients were recruited. Significant difference of platelet reactivity was found betweenCYP2C19*2 carriers and non-carriers (P=0.001), but not forCYP2C19*3 (P=0.884). The patients carrying CYP2C19*2 allele or at least one CYP2C19 LOF allele had significantly higher incidence ofcardiovascular end point events than those non-carriers (P<0.05). Compared with non-carriers, the risk of rehospitalization for angina was significantly higher in the CYP2C19*2 allele carriers[adjustedodds ratio (OR): 1.67, 95%confidence interval (CI): 1.05-2.65,P=0.010]. What’s more, the risk of combined cardiovascular events (adjusted OR: 1.22, 95% CI: 1.03-1.98,P=0.049) and the incidence of rehospitalization for angina (adjusted OR: 1.67, 95% CI: 1.04-2.68,P=0.032)were significantlyhigherin the CYP2C19 LOF allele carriers thanin non-carriers.Conclusion CYP2C19LOF allelesare closely relatedtotheplatelet reactivity of clopidorgrel inthe elderly CHD patients after PCI. Thegenetic variants significantly weakens the effect of antiplatelet therapy ofclopidogrel,andthussignificantly increases the risk of cardiovascularend pointevents after PCI.