氯吡格雷对冠心病患者PCI术后CYP2C19、PON1 基因多态性与FIB、D-二聚体水平的相关性研究

氯吡格雷对冠心病患者PCI术后CYP2C19、PON1 基因多态性与FIB、D-二聚体水平的相关性研究

廉悦,杨雅清,张阳,宋沧桑

昆明市第一人民医院,昆明市第一人民医院,昆明市第一人民医院,昆明市第一人民医院

收稿日期:2018-11-15 修回日期:2019-04-02 出版日期:2019-04-25 发布日期:2019-04-25

Correlation between CYP2C19， PON1 Gene Polymorphisms and Levels of FIB， D-Dimer in Patients with Coronary Heart Disease Treated with Clopidogrel after PCI

lianyue,, and

First people''s Hospital of Kunming,First people''s Hospital of Kunming,First people''s Hospital of Kunming,First people''s Hospital of Kunming

Received:2018-11-15 Revised:2019-04-02 Online:2019-04-25 Published:2019-04-25

摘要/Abstract

摘要： 目的：分析冠心病患者经皮冠状动脉介入治疗(PCI)术后，规律服用氯吡格雷治疗时CYP2C19、PON1基因多态性与血浆纤维蛋白原（FIB）、D-二聚体水平的相关性研究。方法：选取在某三甲医院确诊为冠心病且行PCI术的患者217例，对217例患者行CYP2C19*2、CYP2C19*3、CYP2C19*17、PON1基因监测，观察患者在规律服用氯吡格雷治疗（75 mg·d-1）1个月以上的血浆FIB、D-二聚体指标。结果：在217名患者中CYP2C19* 17基因未检测出突变型等位基因，因此对超快代谢型基因不做统计分析。CYP2C19基因的快代谢型、中间代谢型、慢代谢型之间的FIB指标对比均无统计学差异（P>0.05）；快代谢型与中间代谢型、快代谢性与慢代谢型之间的D-二聚体指标均无统计学差异（P>0.05）；中间代谢型与慢代谢型之间D-二聚体指标有统计学差异（P<0.05）。PON1基因GG型与GA型、GG型与AA型、GA型与AA型的FIB和D-二聚体指标水平均无统计学差异（P>0.05）。结论：携带CYP2C19慢代谢基因型的患者使用常规氯吡格雷剂量治疗，增加血栓风险，可考虑适当增加氯吡格雷服药剂量或改服替格瑞洛进行溶栓治疗。PON1基因多态性与氯吡格雷治疗血小板反应性差异并无关联性。

Abstract: Objective： Analyze the correlation between CYP2C19， PON1 gene polymorphisms and FIB and D-Dimer levels in patients with coronary heart disease in Yunnan after PCI. Methods：217 patients diagnosed with coronary heart disease and undergoing PCI in a top three hospital. CYP2C19*2， CYP2C19*3，CYP2C19*17 and PON1 gene monitoring were performed in all patients. Observe the plasma FIB and D-Dimer indicators of patients who regularly took clopidogrel（75 mg·d-1） for more than one month. Results：No mutational allele was detected in the CYP2C19*17 gene in 217 patients， so the ultrafast metabolome group was not statistically analyzed. There was no statistically significant difference in the FIB index between the fast metabolite， intermediate metabolite and slow metabolites of CYP2C19 gene (P>0.05). There was no significant difference in D-Dimer between fast metabolite and intermediate metabolite， fast metabolizing and slow metabolizing (P>0.05). There was a statistically significant difference between the D-Dimer index between the intermediate metabolite and the slow metabolite (P<0.05). There was no significant difference in the PON1 gene GG type and GA type， GG type and AA type， GA type and AA type FIB and D-Dimer index (P>0.05). Conclusion：Patients with CYP2C19 slow-metabolizing genotypes have an increased risk of thrombosis when treated with conventional clopidogrel doses. Should be appropriate to increase the dose of clopidogrel or change to telgrelor for thrombolytic therapy. There was no association between PON1 gene polymorphism and clopidogrel in the treatment of platelet reactivity.

廉悦,杨雅清,张阳,宋沧桑. 氯吡格雷对冠心病患者PCI术后CYP2C19、PON1 基因多态性与FIB、D-二聚体水平的相关性研究[J]. .

lianyue,, and. Correlation between CYP2C19， PON1 Gene Polymorphisms and Levels of FIB， D-Dimer in Patients with Coronary Heart Disease Treated with Clopidogrel after PCI[J]. .

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