本文選題：CYP2C19 + 氯吡格雷��； 參考：《河北醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:分析冠心病患者CYP2C19基因型檢測與經(jīng)氯吡格雷治療前后通過光學(xué)比濁法測定血小板聚集率的相關(guān)性。方法:入選自2016年2月至2017年2月期間、河北醫(yī)科大學(xué)第二醫(yī)院心血管內(nèi)五科收治的冠心病患者�；颊呷朐呵拔唇邮苋魏慰寡“逯委�,入院給予300mg氯吡格雷+300mg阿司匹林負(fù)荷量后,以75mg氯吡格雷+100mg阿司匹林每天持續(xù)治療。分別以光學(xué)比濁法檢測患者服用氯吡格雷抗血小板治療前與治療3天后的血小板聚集率。所有患者均以熒光染色原位雜交法定性檢測CYP2C19基因型。根據(jù)CYP2C19基因型檢測結(jié)果及所支配的酶分為三種不同的代謝類型:正常代謝型(RM,*1/*1)、慢代謝型(PM,*2/*2,*2/*3,*3/*3),中間代謝型(IM,*1/*2,*1/*3,*17/*2,*17/*3)。通過光學(xué)比濁法檢測血小板聚集率變化,將兩次血小板聚集率均50%的患者定義為高反應(yīng)組,第二次血小板聚集率下降至50%,定義為反應(yīng)正常組,觀察兩組患者指標(biāo):年齡、性別、體重指數(shù)、血小板計數(shù)、血紅蛋白計數(shù)、左室射血分?jǐn)?shù)、合并糖尿病、高血壓、血脂異常等疾病、吸煙、PPI用藥史等。統(tǒng)計分析采用SPSS 21.0軟件,應(yīng)用二元logistic回歸分析氯吡格雷藥物治療后反應(yīng)性與代謝基因型的相關(guān)性。將雙側(cè)P0.05視為有差異有統(tǒng)計學(xué)意義。結(jié)果:1本試驗共納入患者46例,其中女性患者15(32.6%)例,男性患者31例(67.4%),年齡36-75歲,平均為58.8±9.5,吸煙患者21例(45.6%),高血壓患者33例(71.7%),糖尿病患者18例(39.1%),血脂異�；颊�25例(54.3%)。對所有患者進(jìn)行CYP2C19基因型檢測,其中正常代謝型患者22例(47.8%),中間代謝型15例(32.6%),慢代謝型患者9人(19.5%),藥物反應(yīng)正常組33人(71.7%),高反應(yīng)性組13人(28.3%)。2入院時,正常代謝型組患者血小板聚集率水平為86.4±6.7%,中間代謝型組為87.9±4.8%,慢代謝型組為89.8±3.2%,三組數(shù)據(jù)統(tǒng)計學(xué)無差異(P0.05)。用藥3天后,正常代謝型組的血小板聚集率為34.8±8.2%,中間代謝型組為45.4±5.8%,慢代謝型組為64.0±5.5%,三組數(shù)據(jù)統(tǒng)計學(xué)上有差異(P0.05)。3氯吡格雷藥物治療后,高反應(yīng)性組和反應(yīng)正常組兩組患者在年齡、性別、體重指數(shù)、血小板計數(shù)、合并糖尿病、高血壓、血脂異常、吸煙,PPI用藥等方面兩者并無統(tǒng)計學(xué)差異(All P0.05)。4在三種代謝型中,反應(yīng)正常的患者和高反應(yīng)性患者數(shù)量具有差異,且差異具有統(tǒng)計學(xué)意義(P0.05);二元Logistic回歸分析藥物反應(yīng)性與代謝基因型的相關(guān)性,結(jié)果顯示,患者藥物治療后反應(yīng)性與CYP2C19基因型檢測具有相關(guān)性(P=0.01,OR=10.096)。結(jié)論:光學(xué)比濁法測定血小板聚集率與CYP2C19代謝基因型檢測具有顯著相關(guān)性。
[Abstract]:Objective: to analyze the correlation between CYP2C19 genotypes and platelet aggregation by optical turbidimetry before and after clopidogrel treatment. Methods: patients with coronary heart disease were selected from February 2016 to February 2017. The patient received no antiplatelet therapy before admission and continued daily treatment with 75mg clopidogrel 100mg aspirin after admission to 300mg clopidogrel 300mg aspirin load. The platelet aggregation rate was measured by optical turbidimetry before and 3 days after antiplatelet therapy with clopidogrel. CYP2C19 genotypes were detected qualitatively by fluorescence staining in situ hybridization in all patients. According to the results of CYP2C19 genotypic analysis and the controlled enzymes, there are three different metabolic types: the normal metabolic type is 1 / 1 / 1, the slow metabolic type is 2 / 2 / 2 / 10 / 3 / 3, and the intermediate metabolic type is 1 / / 2 / 3 / 3 / 3 / 3 / 3 / 3 / 3 / 3 / 3 / 3 / 3 / 3 / 3 / 3 / 3 / 3 / 3 / 3 / 3 / 3 / 3 / 3 / 3 / 3 / 3 / 3 / 3 / 3 / 3 / 2 / 3 / 3 / 3 / 3 / 3 / 3 / 2 / 3 / 3 / 3 / 3 The change of platelet aggregation rate was determined by optical turbidimetry. The patients with 50% platelet aggregation rate at both times were defined as high reaction group, and the second platelet aggregation rate was reduced to 50. The second platelet aggregation rate was defined as the normal reaction group. Body mass index, platelet count, hemoglobin count, left ventricular ejection fraction, diabetes mellitus, hypertension, dyslipidemia, smoking history of PPI. SPSS 21.0 software was used to analyze the correlation between reactivity and metabolic genotype by binary logistic regression analysis after clopidogrel treatment. There was significant difference between the two sides. Results A total of 46 patients were included in the study, including 153.66 female patients and 31 male patients with a mean age of 58.8 鹵9.5 years, aged 36-75 years, 21 patients with smoking, 33 patients with hypertension, 33 patients with hypertension, 39.1patients with diabetes mellitus, 25 patients with dyslipidemia and 54.3patients with dyslipidemia. CYP2C19 genotypes were detected in 22 patients with normal metabolic type, 15 patients with intermediate metabolic type, 9 patients with slow metabolic type, 33 patients with normal drug reaction, and 13 patients with hyperreactivity. The platelet aggregation rate was 86.4 鹵6.7in the normal metabolic type group, 87.9 鹵4.8 in the intermediate metabolic type group and 89.8 鹵3.2 in the slow metabolic type group. There was no statistical difference among the three groups (P 0.05). After 3 days treatment, the platelet aggregation rate was 34.8 鹵8.2 in the normal metabolic type group, 45.4 鹵5.8 in the intermediate metabolic type group and 64.0 鹵5.5 in the slow metabolic type group. There was no significant difference in sex, body mass index, platelet count, diabetes mellitus, hypertension, dyslipidemia, smoking and PPI use. Among the three metabolic types, there were significant differences in the number of patients with normal reaction and those with hyperreactivity. The correlation between drug reactivity and metabolic genotype was found by binary Logistic regression analysis. The results showed that there was a correlation between drug reactivity and CYP2C19 genotypes after drug therapy. Conclusion: optical turbidimetry has a significant correlation with CYP2C19 metabolic genotypes.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R541.4

【參考文獻(xiàn)】

相關(guān)期刊論文 前1條

1 ;抗血小板治療中國專家共識[J];中華心血管病雜志;2013年03期

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本文編號：1800783