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目的研究不同CYP2C19基因分型对急性冠脉综合征患者氯吡格雷抗血小板效能的影响。方法入选2015年1月-2016年1月在中山大学附属第三医院诊断为急性冠脉综合征患者301例,入院时抽血检测CYP2C19基因多态性,按基因型分为快代谢型、中等代谢型和慢代谢型3组。入院当天给予拜阿司匹林标准剂量和负荷量氯吡格雷300 mg,之后常规剂量氯吡格雷75 mg/d。分别于入院第1 d和第7 d测血浆二磷酸腺苷(ADP浓度)诱导的血小板聚集率。结果服用氯吡格雷前,3组间血小板聚集率比较差异无统计学意义。服用氯吡格雷7 d后,3组血小板聚集率较服药前下降,差异均有统计学意义(P<0.05)。结论对于急性冠脉综合征患者,及时检测CYP2C19基因多态性对指导临床上抗血小板药物的治疗具有重要意义。
Objective To investigate the effect of different CYP2C19 genotypes on antiplatelet efficacy of clopidogrel in patients with acute coronary syndrome. Methods Selected from January 2015 to January 2016 in the Third Affiliated Hospital of Sun Yat-sen University, 301 cases of patients diagnosed as acute coronary syndromes, blood samples were taken to detect CYP2C19 gene polymorphism, genotypes were divided into fast metabolism, moderate Metabolism and slow metabolism 3 groups. On the day of admission, aspirin was given as a standard dose and a loading dose of clopidogrel 300 mg, followed by a conventional dose of clopidogrel 75 mg / d. The platelet aggregation rate induced by adenosine diphosphate (ADP) was measured on the 1st day and the 7th day after admission respectively. Results Before taking clopidogrel, there was no significant difference in platelet aggregation rate among the three groups. After taking clopidogrel for 7 days, the platelet aggregation rate of the three groups was lower than that before taking the drug, the differences were statistically significant (P <0.05). Conclusions In patients with acute coronary syndrome, timely detection of CYP2C19 gene polymorphism is of great importance for the treatment of clinical antiplatelet drugs.