回顧性分析氯吡格雷弱代謝患者的抗血小板治療現狀

劉 娜，張抗懷*，董 新，王海濤

(1.西安交通大學第二附屬醫院藥學部，西安 710004；2. 西安交通大學第二附屬醫院心內科，西安 710004)

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回顧性分析氯吡格雷弱代謝患者的抗血小板治療現狀

劉 娜1，張抗懷1*，董 新2，王海濤1

(1.西安交通大學第二附屬醫院藥學部，西安 710004；2. 西安交通大學第二附屬醫院心內科，西安 710004)

目的 篩查氯吡格雷弱代謝型急性冠脈綜合征患者，回顧性分析其抗血小板治療現狀。方法 選取醫院收治的285例陜西漢族急性冠脈綜合征患者，通過焦磷酸測序技術檢測CYP2C19*2和CYP2C19*3基因多態性篩查氯吡格雷弱代謝患者，分析其抗血小板治療現狀。結果 在285例患者中，快代謝型占38.6%，中間代謝型占49.1%，慢代謝型占12.3%，后兩者為弱代謝型(61.4%)。中間代謝型患者，53.6%應用氯吡格雷75 mg·d-1；46.4%調整治療方案，如氯吡格雷劑量加倍至150 mg·d-1，更換替格瑞洛或三聯療法(加用西洛他唑)。慢代謝型患者，54.3%應用氯吡格雷75 mg·d-1，45.7%調整為上述治療方案，其中28.5%更換替格瑞洛。結論 在陜西漢族急性冠脈綜合征患者中，氯吡格雷弱代謝型發生率高，目前個體化抗血小板治療方案并無統一規范。

氯吡格雷；弱代謝型；急性冠脈綜合征；抗血小板治療

A.stract:Objective To identify the clopidogrel poor metabolizers with acute coronary syndrome (ACS) and to retrospectively analyze the antiplatelet therapy status. Methods 285 Shaanxi Han Chinese with (ACS) in the hospital were enrolled in this study. The pyrophosphate sequencing technology was used to detect CYP2C19*2 and CYP2C19*3 gene polymorphism. Antiplatelet therapy status of clopidogrel poor metabolizers with ACS was analyzed. Results The rapid，intermediate and slow metabolizers were respectively 38.6%， 49.1% and 12.3%. The intermediate and slow metabolizers were regarded as clopidogrel poor metabolizers(61.4%). About 53.6% clopidogrel intermediate metabolizers were given conventional dose of clopidogrel (75 mg·d-1) ，46.4% cases were applied the adjusted treatment plans including doubling dosage of clopidogrel (150 mg·d-1)，replacement drugs (such as ticagrelor) or triple antiplatelet therapy (adding cilostazol). For clopidogrel slow metabolizers，54.3% cases were still given conventional dose of clopidogrel (75 mg·d-1)，45.7% patients were administered the adjusted treatment plans as mentioned above，28.8% of patients with replacement of ticagrelor.Conclusion The incidence of clopidogrel poor metabolizers is high in Shaanxi Han Chinese population with ACS. There is no uniform standard that individualized antiplatelet treatment of clopidogrel poor metabolizers.

氯吡格雷是急性冠脈綜合征患者抗血小板治療的基礎用藥[1]，給予常規劑量氯吡格雷治療患者依從性良好，但部分患者血小板活性不能達到有效抑制或發生不良心血管事件，即氯吡格雷抵抗現象。臨床研究證實，氯吡格雷療效存在明顯個體差異，CYP2C19基因多態性是影響氯吡格雷療效的重要內因[2-3]。……