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目的:通过探讨CPY2C19基因多态性与抗血小板活性的相关性,明确中国人群冠心病患者中CPY2C19基因多态性与血栓弹力图相关性,提出个体化给药建议,确保患者疗效,提升临床药学学科服务水平。方法:临床药师按照患者的疾病诊断、现病史以及主诉等进行初步入组100名冠心病患者,通过药师工作站等工作平台实时跟踪患者的抗血小板治疗方案的调整,并在日常床旁问诊中了解患者的抗血小板治疗效果。对于确定入组的患者应跟踪并详细记录其血栓弹力图以及CYP2C19基因型的测定结果,以便后期确定氯吡格雷相关基因多态性在冠心病患者中的分布规律以及氯吡格雷相关基因型与剂量调整及血小板聚集率的相关性。结果:100例入组患者,慢代谢型有16例,占16%,中间代谢型36%,快代谢型为48%。在45例患者血栓弹力图中,ADP抑制率不达标者占62.2%(28/45)。结论:临床药师与临床医师应根据血栓弹力图与CYP2C19的基因测定相结合,最终确定患者的个体化抗血小板治疗方案。建议冠心病患者应尽快进行氯吡格雷基因型测定,在治疗期间可根据临床疗效适当进行血栓弹力图进行抗血小板活性验证。
OBJECTIVE: To explore the correlation between CPY2C19 gene polymorphism and thrombus elasticity in Chinese patients with coronary heart disease by discussing the correlation between CPY2C19 gene polymorphism and antiplatelet activity, and to put forward individualized administration recommendations to ensure the efficacy of patients and improve clinical pharmacology Discipline service level. Methods: According to the patient’s disease diagnosis, current medical history and chief complaint, clinical pharmacists initially enrolled 100 patients with coronary heart disease. The pharmacist workstation and other working platforms were used to track the patient’s adjustment of antiplatelet therapy in real time. Understand the patient’s anti-platelet effect. For patients identified to enter the group should follow and detailed records of the thromboelastogram and CYP2C19 genotyping results in order to determine later distribution of clopidogrel-related gene polymorphisms in patients with coronary heart disease and clopidogrel-related genotypes and Dose adjustment and platelet aggregation rate. Results: Of the 100 patients enrolled, there were 16 cases of slow metabolism, accounting for 16%, 36% of intermediate metabolism and 48% of fast metabolism. Thromboelastography in 45 patients, ADP inhibition rate of non-compliance accounted for 62.2% (28/45). CONCLUSIONS: Clinical pharmacists and clinicians should conclude their individualized antiplatelet regimen based on the thrombi elastography and CYP2C19 genetic assay. It is suggested that patients with coronary heart disease should be clopidogrel genotype determination as soon as possible, during the treatment can be based on clinical efficacy appropriate thrombus elasticity map anti-platelet activity verification.