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投稿时间：2022-03-31 网络发布日期：2022-10-20
投稿时间：2022-03-31 网络发布日期：2022-10-20
中文摘要: 目的 探讨CYP2C19基因联合血小板功能检测（PFT）指导复杂经皮冠状动脉介入术（PCI）术后抗血小板治疗的应用及其疗效。
方法 选取2019年1月至2021年1月因复杂冠状动脉（冠脉）病变于沧州市中心医院行PCI的患者136例进行前瞻性研究，按随机数字表法分为观察组及对照组各68例。PCI术前两组均口服阿司匹林联合氯吡格雷抗血小板治疗，且已达到各300 mg剂量。PCI术后，观察组根据CYP2C19基因检测区分不同代谢型，将中间代谢型进行PFT后的低反应患者以及慢代谢型视为氯吡格雷抵抗,对其双联抗血小板中的氯吡格雷调整为替格瑞洛；对照组仍用阿司匹林和氯吡格雷。观察PCI术后4周血清心肌肌钙蛋白（cTnI）、肌酸激酶同工酶（CK-MB）、超敏C-反应蛋白（hs-CRP）水平，并统计PCI〖JP2〗术后1、12个月主要不良心血管事件（MACE）及出血事件。
结果 术后4周观察组血清cTnI、hs-CRP及CK-MB水平均低于对照组（P<0.05,P＜0.01）。术后1个月，观察组和对照组MACE总发生率比较，差异无统计学意义（2.94% vs 5.88%，P＞0.05）；术〖KG(-2x〗后12个月，观察组MACE总发生率显著低于对照组（8.82% vs 23.53%，P＜0.05）。观察组和对照组出血总发生率比较差异无统计学意义（10.29% vs 8.82%，P＞0.05）。
结论 CYP2C19基因联合PFT在指导复杂PCI术后抗血小板治疗1个月内能改善心肌损伤及炎性指标，并能降低术后12个月内MACE，且不增加总体出血风险。
Abstract:ObjectiveTo investigate the antiplatelet effect of CYP2C19 gene combined with platelet function test(PFT) after complex percutaneous coronary intervention(PCI).
Methods A total of 136 patients with complex coronary artery lesions underwent PCI in Cangzhou Central Hospital from January 2019 to January 2021 were selected
for prospective research, and were randomly divided into observation group and control group(n=68, each). Before PCI, aspirin combined with clopidogrel was given in both groups, and the dosage reached 300 mg each. After PCI, in observation group, different metabolic types were distinguished according to the detection of CYP2C19 gene； the patients with low response after PFT of the intermediate metabolic type and the patients with gene slow metabolic type were considered to be clopidogrel resistance, and the clopidogrel in the dual antiplatelet was adjusted to ticagrelor. In control group, aspirin and clopidogrel were still used. At 4 weeks after PCI, the serum levels of cardiac tmponin I(cTnI), creatine kinase MB isoenzyme(CK-MB) and high-sensitivity C-reactive protein(hs-CRP) were detected, and the major adverse cardiovascular events(MACE) and the bleeding events were observed at 1 month and 12 months after PCI.
Results The serum levels of cTnI, hs-CRP and CK-MB in observation group were significantly lower than those in control group(P＜0.05,P<0.01). At 1 month after surgery, there was no significant difference in the total incidence of MACE between observation group and control group(2.94% vs 5.88%, P＞0.05), however, at 12 months after surgery that in observation group was significantly lower compared with control group (8.82% vs 23.53%, P＜0.05). There was no statistical difference in the total incidence of bleeding between observation group and control group(10.29% vs 8.82%, P＞0.05).
Conclusion CYP2C19 gene combined with PFT can improve myocardial injury and inflammatory indexes within 1 month through guiding antiplatelet therapy after complex PCI, and reduce MACE within 12 months after operation without increasing the bleeding risk.
keywords: CYP2C19 gene Platelet function test Slow metabolic type Intermediate metabolic type Clopidogrel resistance Complex percutaneous coronary intervention Antiplatelet therapy
文章编号： 中图分类号：R541.4 文献标志码：A
基金项目:河北省医学科学研究课题计划项目（20200176）
| Author Name | Affiliation |
| YU Jian-cai， PENG Wan-zhong， LIU Yong-xing， JIANG Yang， LIU Juan， XU Ze-sheng | Department of Cardiology, Cangzhou Central Hospital， Cangzhou, Hebei 061000, China |
引用文本：
于建才，彭万忠，刘永兴，姜洋，刘娟，徐泽升.CYP2C19基因联合血小板功能检测指导复杂PCI术后的抗血小板疗效[J].中国临床研究,2022,35(10):1344-1348.
于建才，彭万忠，刘永兴，姜洋，刘娟，徐泽升.CYP2C19基因联合血小板功能检测指导复杂PCI术后的抗血小板疗效[J].中国临床研究,2022,35(10):1344-1348.