关键词: 替格瑞洛, 氯吡格雷, 血小板聚集率, 氯吡格雷基因检测

Abstract: Objective To investigate the role of CYP2C19 gene polymorphism and platelet function detection in the anti-platelet strategies in the clinical prognosis of patients after percutaneous coronary intervention. Methods From October 2017 to February 2018, a total of 200 with coronary heart disease undergoing percutaneous coronary intervention (PCI) were included, 190 of which were successfully followed up. According to genotype, the patients were divided into normal metabolism of clopidogrel (ultrafast and fast metabolism) and abnormal metabolism (intermediate and slow metabolism). According to the platelet aggregation rate, patients were divided into the normal clopidogrel reaction (NCR) type (maximum platelet aggregation rate<46) and the resistance type, i.e., low clopidogrel (LCR) type (maximum platelet aggregation rate≥46). Group A included normal metabolism of clopidogrel and NCR type, Group B included abnormal metabolism or abnormal clopidogrel resistance type. Group C included both abnormal types. The groups A and B were treated with aspirin and clopidogrel,while the group C were treated with aspirin and ticagrelor. Follow up the major adverse cardiovascular events and bleeding events within 12 months. Results The general clinical data (gender, age, smoking, drinking, hypertension, diabetes, hyperlipidemia), clinical medication [angiotensin converting enzyme inhibitor(ACEI) and angiotension receptor blocker(ARB), beta blockers, calcium-channel antagonist(CCB), proton pump inhibitor (PPI), nitrate medications], biochemical criterion (creatinine, uric acid, transaminase), and PCI surgery (multivessel lesions, stents of number, diameter, length) showed no statistical difference (P>0.05). The incidence of major adverse cardiac events (MACEs) and the target vessels re-revascularization had significant difference in three groups(P＜0.05). The incidence of target vessels re-revascularization in group C was decreased, with a statistically significant difference compared with group B (0 vs 11%).There were no statistically significant differences in cardiogenic death, nonfatal myocardial infarction, and recurrent angina pectoris (P>0.05). No MACEs were observed in all the groups. The incidence of dyspnea in group C was higher than that in group A and group B, without statistical significance. Conclusions Aspirin combined with ticagrelon antiplatelet therapy could reduce the incidence of adverse cardiovascular events, without increasing the incidence of bleeding events, and improve the prognosis of clopidogrel hyporeactive patients screened by CYP2C19 genotype combined with platelet function detection.

Key words: ticagrelor, clopidogrel, platelet aggregation rate, clopidogrel gene detection