CYP2C19多态性对氯吡格雷及丹参多酚酸盐临床疗效的差异性研究
摘要
目的:探讨基因CYP2C19多态性个体化治疗中,氯吡格雷和中药制剂丹参多酚酸盐抑制血小板聚集的初步机制。方法:随机将105例分为四组进行治疗,通过一般资料及测定生化指标和血栓弹力图,检测各组CYP2C19基因型和NIHSS评分等,分析四组患者的血小板抑制情况,比较各组结果。结果:整体水平上,各组经药物治疗后,血小板抑制率显著提高,但是对于突变型CYP2C19*2,CYP2C19*3患者,会产生氯吡格雷抵抗,而丹参多酚酸盐治疗对CYP2C19基因多态性患者没有显著差异。结论:氯吡格雷会对突变型CYP2C19基因产生抵抗,而中药制剂丹参多酚酸盐也可以抑制血小板聚集发挥药效,且对CYP2C19基因多态性不敏感。
引文
[1] 中华医学会神经病学分会脑血管病学组缺血性脑卒中二级预防指南撰写组.中国缺血性脑卒中和短暂性脑缺血发作二级预防指南 2010[J].中华神经科杂志,2010,43(2):154.
[2] Kernan WN,Ovbiagele B,Black HR,et al.Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack:a guideline forhealthcare professionals from the American Heart Association/American Stroke Association[J].Stroke,2014,45(7):2160.
[3] 刘玲,侯华娟,刘亚红,等.用血栓弹力图评价阿司匹林及氯吡格雷在缺血性卒中患者中血小板抑制效应的研究[J].中风与神经疾病杂志,2012,29(5):446.
[4] 董瑨堃,孟舒,陈俊文,等.血栓弹力图预测CYP2C19基因型对指导经皮冠状动脉介入术后氯吡格雷治疗的价值[J].第二军医大学学报,2013,34(7):732.
[5] 杨佳,羊镇宇.CYP2C19基因多态性与氯吡格雷抵抗的研究现状[J].临床心血管病杂志,2012,28(3):163.
[6] 谢婧,胡欣,杨莉萍.CYP2C19*17多态性对氯吡格雷临床疗效影响的系统评价[J].中国循证医学杂志,2014,(3):271.
[7] 陈翔,袁小梅.氯吡格雷联合氟伐他汀治疗脑梗死对患者Barthel指数及NIHSS评分的影响[J].中国药业,2016,25(22):59.
[8] 蒋嘉能,刘倩,赵锋.基础NIHSS评分、血管闭塞对预测早期急性脑梗死患者预后的价值[J].中国现代医生,2014,52(7):53.
[9] Megaj L,Closes L,Wiviotts D,et al.Cytochromep-450polymorphismsandresponsetoclopidogrel[J].NEngl J Med,2009,360(4):354.
[10] Kim KA,Park PW,Hong SJ,et al.The effect of CYP2C19 polymorphism on the pharmacokinetics and pharmacodynamics of clopidogrel:a possible mechanism for clopidogrel resistance.Clin Pharmacol Ther,2008,84(2):236.
[11] Chen WH,Cheng X,Lee PY,et al.Aspirin resistance and adverse clinical events in patients with coronary artery disease[J].Am J Med,2007,120(7):631.
[12] 赵冠人,冯端浩,李素,等.CYP2C19基因多态性与氯吡格雷ADP抑制率的相关性研究[J].中国药师,2013,16(4):479.
[2] Kernan WN,Ovbiagele B,Black HR,et al.Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack:a guideline forhealthcare professionals from the American Heart Association/American Stroke Association[J].Stroke,2014,45(7):2160.
[3] 刘玲,侯华娟,刘亚红,等.用血栓弹力图评价阿司匹林及氯吡格雷在缺血性卒中患者中血小板抑制效应的研究[J].中风与神经疾病杂志,2012,29(5):446.
[4] 董瑨堃,孟舒,陈俊文,等.血栓弹力图预测CYP2C19基因型对指导经皮冠状动脉介入术后氯吡格雷治疗的价值[J].第二军医大学学报,2013,34(7):732.
[5] 杨佳,羊镇宇.CYP2C19基因多态性与氯吡格雷抵抗的研究现状[J].临床心血管病杂志,2012,28(3):163.
[6] 谢婧,胡欣,杨莉萍.CYP2C19*17多态性对氯吡格雷临床疗效影响的系统评价[J].中国循证医学杂志,2014,(3):271.
[7] 陈翔,袁小梅.氯吡格雷联合氟伐他汀治疗脑梗死对患者Barthel指数及NIHSS评分的影响[J].中国药业,2016,25(22):59.
[8] 蒋嘉能,刘倩,赵锋.基础NIHSS评分、血管闭塞对预测早期急性脑梗死患者预后的价值[J].中国现代医生,2014,52(7):53.
[9] Megaj L,Closes L,Wiviotts D,et al.Cytochromep-450polymorphismsandresponsetoclopidogrel[J].NEngl J Med,2009,360(4):354.
[10] Kim KA,Park PW,Hong SJ,et al.The effect of CYP2C19 polymorphism on the pharmacokinetics and pharmacodynamics of clopidogrel:a possible mechanism for clopidogrel resistance.Clin Pharmacol Ther,2008,84(2):236.
[11] Chen WH,Cheng X,Lee PY,et al.Aspirin resistance and adverse clinical events in patients with coronary artery disease[J].Am J Med,2007,120(7):631.
[12] 赵冠人,冯端浩,李素,等.CYP2C19基因多态性与氯吡格雷ADP抑制率的相关性研究[J].中国药师,2013,16(4):479.