我国部分地区冠心病患者CYP2C19基因多态性分布特征及意义的Meta分析
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摘要
目的探讨与氯吡格雷代谢相关的细胞色素P450(CYP2C19)基因型在我国冠状动脉粥样硬化性心脏病(冠心病)患者中的分布特征及其意义。方法应用冠心病、CYP2C19关键词于数据库检索。根据纳入和排除标准筛选文献,制订数据提取表提取数据。采用StatsDirect软件合并相同地域和种族CYP2C19的6种基因型(*1/*1、*1/*2、*1/*3、*2/*2、*2/*3、*3/*3)发生率。结果氯吡格雷代谢相关的CYP2C19慢代谢基因型(*2/*2、*2/*3、*3/*3)在我国部分地区冠心病患者中发生率为4.29%～24.66%;快代谢基因型(*1/*1)在云南冠心病患者中最低,为36.22%;慢代谢基因型(*2/*2、*2/*3、*3/*3)在浙江冠心病人群中最高,为24.66%。结论我国部分地区冠心病患者携带的与氯吡格雷代谢相关的CYP2C19基因型有明显地域和种族差异。中、慢代谢基因型在我国部分地区冠心病患者中仍占较高比率,建议冠心病患者在应用氯吡格雷治疗前筛查其相关CYP2C19基因型。
Objective To explore the distribution characteristics and significance of CYP2 C19 gene polymorphisms associated with clopidogrel metabolism in Chinese patients with coronary heart disease(CHD).Methods The keywords of coronary heart disease and CYP2 C19 were used to retrieve the database.Literatures were screened and data extraction tables were drawn up according to inclusion and exclusion criteria.6 genotypes(*1/*1,*1/*2,*1/*3,*2/*2,*2/*3,*2/*3)of CYP2 C19 from the same region and race were merged using StatsDirect software.Results The incidence of slow metabolic genotype was 4.29%-24.66%in CHD patients in some areas of China.Clopidogrel fast metabolic genotype(*1/*1)was the lowest accounting for 36.22%in CHD patients in Yunnan Province,while slow metabolic genotype(*2/*2,*2/*3,*3/*3)was the highest in CHD patients in Zhejiang Province,accounting for 24.66%.Conclusion The CYP2 C19 genotype related to clopidogrel metabolism carried by CHD patients in some areas of China has obvious regional and ethnic differences.Medium and slow metabolic genotypes still account for a high proportion of CHD patients in some areas of China.It is suggested that CHD patients should screen for CYP2 C19 genotypes before clopidogrel treatment.
Objective To explore the distribution characteristics and significance of CYP2 C19 gene polymorphisms associated with clopidogrel metabolism in Chinese patients with coronary heart disease(CHD).Methods The keywords of coronary heart disease and CYP2 C19 were used to retrieve the database.Literatures were screened and data extraction tables were drawn up according to inclusion and exclusion criteria.6 genotypes(*1/*1,*1/*2,*1/*3,*2/*2,*2/*3,*2/*3)of CYP2 C19 from the same region and race were merged using StatsDirect software.Results The incidence of slow metabolic genotype was 4.29%-24.66%in CHD patients in some areas of China.Clopidogrel fast metabolic genotype(*1/*1)was the lowest accounting for 36.22%in CHD patients in Yunnan Province,while slow metabolic genotype(*2/*2,*2/*3,*3/*3)was the highest in CHD patients in Zhejiang Province,accounting for 24.66%.Conclusion The CYP2 C19 genotype related to clopidogrel metabolism carried by CHD patients in some areas of China has obvious regional and ethnic differences.Medium and slow metabolic genotypes still account for a high proportion of CHD patients in some areas of China.It is suggested that CHD patients should screen for CYP2 C19 genotypes before clopidogrel treatment.
引文
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[3] CUISSET T,MORANGE P E,ALESSI M C.Recent advances in the pharmacogenetics of clopidogrel[J].Hum Genet,2012,131(5):653-664.
[4] ZHANG J,ZHANG H,LI K,et al.Development of a polymerase chain reaction/ligase detection reaction assay for detection of CYP2C19 polymorphisms[J].Genet Test Mol Biomarkers,2018,22(1):62-73.
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[7]吴龙梅,田新利,李俊峡.CYP2C19基因多态性与氯吡格雷低反应发生率的研究[J].中国循证心血管医学杂志,2015,8(4):458-460.
[8]国荣,刘淼,王宇玫,等.北京地区汉族冠心病患者CYP2C19基因多态性分析[J].医学研究杂志,2015,44(11):101-105.
[9]张冬青,王海滨,刘淼,等.CYP2C19、ALDH2和MTHFR基因多态性与冠心病的相关性研究[J].标记免疫分析与临床,2015,22(3):207-210.
[10]张琳,马旭,王燕,等.CYP2C19基因多态性及代谢表型在604例老年冠心病患者中的分布[J].心肺血管病杂志,2015,34(12):887-889.
[11]吴丹,杨胜利,路靖,等.冠心病患者支架术后根据检测药物代谢酶CYP2C19基因调整抗血小板治疗的价值[J].中国循环杂志,2015,30(3):216-219.
[12]张爱玲,刘瑶,杨莉萍,等.经皮冠状动脉介入术后再发不良心血管事件的影响因素分析[J].药物不良反应杂志,2014,16(6):350-355.
[13]吴干斌,周建华,刘科兰.河南汉族冠心病患者CYP2C19基因多态性分布[J].郑州大学学报(医学版),2014,49(4):568-571.
[14]李鹏飞,杨海波,赵荫涛,等.冠心病介入患者氯吡格雷药物代谢相关基因CYP2C19的多态性分布[J].中国实用医刊,2014,41(10):64-65.
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[17]裴媛,周贺伟.CYP2C19基因多态性检测指导经皮冠状动脉介入术后患者氯吡格雷个体化用药[J].中国医院用药评价与分析,2017,17(5):667-669.
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[19]热依汗·依明,帕丽达·阿布来提,古丽扎尔·买买提明.维吾尔族、汉族冠心病人群CYP2C19基因多态性分析[J].心血管康复医学杂志,2014,23(2):127-130.
[20]王盛芳,帕丽达·阿布来提,古丽扎尔·买买提明,等.维吾尔族冠心病合并糖尿病患者CYP2C19基因多态性与血糖的相关性分析[J].临床心血管病杂志,2015,31(10):1064-1067.
[21]陶立霞,帕丽达·阿不来提,古丽扎尔·买买提明.维吾尔族不同体重指数冠心病患者CYP2C19基因多态性分析[J].临床内科杂志,2016,33(2):97-99.
[22]孙宁宁,庞晓.CYP2C19基因检测对冠心病患者氯吡格雷治疗的临床意义[J].临床心血管病杂志,2017,33(4):309-313.
[23]曾敏,熊怡淞,俞娟,等.四川地区冠心病患者CYP2C19基因多态性检测[J].检验医学与临床,2017,14(10):1363-1365.
[24]李勤琴.CYP2C19基因多态性、高水平FIB对氯吡格雷抗凝效应的相关性研究[J].国际检验医学杂志,2016,37(22):3123-3125.
[25]范超,张燕,何建维,等.重庆地区冠心病介入治疗患者CYP2C19基因多态性分布[J].重庆医学,2016,45(11):1549-1551.
[26]韩瑞玲,李艳,吴薇.武汉地区冠心病患者氯吡格雷药物代谢相关基因CYP2C19的多态性分布分析[J].现代检验医学杂志,2015,30(3):21-23.
[27]李琳,李居怡,王德昭,等.武汉地区123例冠心病患者CYP2C19基因多态性分布[J].昆明医科大学学报,2017,38(6):60-63.
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[29]庄金龙,邓节喜,陈劲松,等.CYP2C19基因多态性与PCI手术患者血小板抑制率的相关性研究[J].中国心血管病研究,2017,15(6):518-522.
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[31]吕园,俞杨,张秀梅,等.南京及周边地区冠心病患者CYP2C19基因多态性分析[J].标记免疫分析与临床,2016,23(10):1139-1143.
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[33]韩兆欢,吕冬梅,汤道权,等.淮海地区汉族冠心病患者CYP2C19基因多态性分析[J].徐州医学院学报,2016,36(10):652-655.
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[36]胡瑛,谈红,陈英剑,等.冠心病PCI患者CYP2C19基因多态性与氯吡格雷抵抗及预后关系[J].中国分子心脏病学杂志,2015,15(2):1250-1255.
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