CAJ | 학술논문

目的：探讨CYP2C19基因多态性指导下的抗血小板个体化治疗对冠状动脉粥样硬化性心脏病（冠心病）支架植入术后患者临床预后的影响。方法入选2013年11月至2014年5月因急性冠脉综合征（ACS）就诊并成功完成经皮冠状动脉介入术（PCI）的患者338例，最终纳入符合条件的患者301例。随机分为常规治疗组和个体化治疗组两组，常规治疗组给予阿司匹林+氯吡格雷抗血小板治疗，个体化治疗组根据CYP2C19基因多态性分为LOF+组和LOF-组，LOF+组给予阿司匹林+替格瑞洛治疗，LOF-组仍给予阿司匹林+氯吡格雷治疗。随访9~12个月内主要出血事件和心血管缺血事件的发生率。结果两组患者性别、年龄、高血压、糖尿病、高脂血症、吸烟多支病变、支架植入数目、辅助检查（总胆固醇、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、空腹血糖、肌酐、尿酸）等方面均无统计学差异（P均＞0.05）。两组安全终点（主要出血事件）和疗效终点（主要不良心血管事件、支架内血栓、再发心绞痛）均无统计学差异（P均＞0.05）。结论根据基因多态性指导抗血小板治疗未能降低心血管终点事件的发生。
목적：탐토CYP2C19기인다태성지도하적항혈소판개체화치료대관상동맥죽양경화성심장병（관심병）지가식입술후환자림상예후적영향。방법입선2013년11월지2014년5월인급성관맥종합정（ACS）취진병성공완성경피관상동맥개입술（PCI）적환자338례，최종납입부합조건적환자301례。수궤분위상규치료조화개체화치료조량조，상규치료조급여아사필림+록필격뢰항혈소판치료，개체화치료조근거CYP2C19기인다태성분위LOF+조화LOF-조，LOF+조급여아사필림+체격서락치료，LOF-조잉급여아사필림+록필격뢰치료。수방9~12개월내주요출혈사건화심혈관결혈사건적발생솔。결과량조환자성별、년령、고혈압、당뇨병、고지혈증、흡연다지병변、지가식입수목、보조검사（총담고순、고밀도지단백담고순、저밀도지단백담고순、공복혈당、기항、뇨산）등방면균무통계학차이（P균＞0.05）。량조안전종점（주요출혈사건）화료효종점（주요불양심혈관사건、지가내혈전、재발심교통）균무통계학차이（P균＞0.05）。결론근거기인다태성지도항혈소판치료미능강저심혈관종점사건적발생。
Objective To investigate the influence of anti-platelet individual treatment guided by CYP2C19 polymorphism on prognosis in patients with coronary heart disease (CHD) after stent implantation.Methods The patients (n=338) hospitalized and accepted success PCI due to acute coronary syndrome (ACS) were chosen from Nov. 2013 to May 2014, and finally 301 eligible patients were brought into the study. All patients were randomly divided into routine group and individual group, and routine group was treated with aspirin+clopidogrel for anti-platelet treatment. The individual group was divided again into LOF+ group and LOF- group according to CYP2C19 polymorphism, and LOF+ group was treated with aspirin+ticagrelor and LOF- group was treated with aspirin+clopidogrel. The incidence rates of major bleeding events and cardiovascular ischemia events were followed up within 9 m to 12 m.Results There was no statistical difference in sex, age, hypertension, diabetes, hyperlipidemia, smoking, multi-vessel lesion, number of stents and auxiliary examinations (total cholesterol, high-density lipoprotein-cholesterol, low-density lipoprotein-cholesterol, fasting plasma glucose, creatinine and uric acid) between 2 groups (allP>0.05). There was no statistical difference in safe endpoint (major bleeding events) and curative effect endpoint (major adverse cardiovascular events, in-stent thrombosis and reoccurrence angina pectoris) between 2 groups (allP>0.05).Conclusion The anti-platelet individual treatment guided by CYP2C19 polymorphism cannot reduce the incidence of cardiovascular endpoint events.