本文關(guān)鍵詞：CYP2C19*2、*3基因多態(tài)性與氯吡格雷臨床療效相關(guān)性的系統(tǒng)評價(jià)，由筆耕文化傳播整理發(fā)布。

中國循證醫(yī)學(xué)雜志 2012, 12(9): 1063～1070

論 著

二次研究

CYP2C19*2、*3基因多態(tài)性與氯吡格雷臨床療效相關(guān)性的系統(tǒng)評價(jià)△

楊莉萍1 謝 婧1,2 劉 瑤1 胡 欣1*

1. 衛(wèi)生部北京醫(yī)院藥學(xué)部（北京 100730）；2. 沈陽藥科大學(xué)藥學(xué)院（沈陽 110016）

摘要 目的 系統(tǒng)評價(jià)心血管疾病患者中植入支架后服用氯吡格雷抗血小板作用效果受CYP2C19*2、*3基因多態(tài)性的影響程度，以期為其安全使用提供證據(jù)。方法 計(jì)算機(jī)檢索EMbase、PubMed、Th e Cochrane Library、Clinical Trial、CBM以及CNKI數(shù)據(jù)庫，查找有關(guān)心血管疾病患者攜帶CYP2C19*2、*3基因與氯吡格雷療效關(guān)系的觀察性研究和臨床試驗(yàn)，檢索時(shí)限均從建庫截至2011年11月。對符合條件的研究，由2位研究者按照納入和排除標(biāo)準(zhǔn)，獨(dú)立篩選文獻(xiàn)、提取資料、評價(jià)質(zhì)量，并交叉核對后，采用RevMan 5.1軟件進(jìn)行Meta 分析。結(jié)果 共納入13篇文獻(xiàn)，包含14個(gè)研究（n=36 855）。Meta分析結(jié)果顯示：植入支架后服用氯吡格雷，，CYP2C19*2、*3和CYP2C19*1基因攜帶者的心血管事件及出血事件發(fā)生率差異均無統(tǒng)計(jì)學(xué)意義，但CYP2C19*2、*3基因攜帶者植入支架后發(fā)生血栓的危險(xiǎn)較CYP2C19*1基因攜帶者明顯增加（P<0.000 1），其在1個(gè)月內(nèi)發(fā)生支架植入后血栓的相對危險(xiǎn)度較CYP2C19*1基因攜帶者增加了92%（P<0.000 1）。結(jié)論 在植入支架后使用氯吡格雷的心血管疾病患者中，CYP2C19*2、*3基因攜帶者比CYP2C19*1基因攜帶者更易發(fā)生支架后血栓，但心血管事件和出血事件發(fā)生率相當(dāng)。鑒于CYP2C19*2、*3基因攜帶者在植入支架后1個(gè)月內(nèi)形成血栓的風(fēng)險(xiǎn)更大，因此，對擬行PCI手術(shù)并用氯吡格雷的患者，我們建議先測CYP2C19基因型，再考慮是否應(yīng)用氯吡格雷抗血小板預(yù)防血栓。

關(guān)鍵詞 氯吡格雷；心血管疾��；CYP2C19；基因多態(tài)性；Meta分析；安全用藥

Correlation between the Genetic Polymorphism of CYP2C19*2, *3 and the Clinical Efficacy of Clopidogrel: A Systematic Review△

YANG Li-ping1, XIE Jing1,2, LIU Yao1, HU Xin1*

1. Department of Pharmacy, Beijing Hospital, Ministry of Public Health, Beijing 100730, China; 2. College of Pharmacy, Shenyang Pharmaceutical University, Shenyang 110016, China

Abstract Objective To systematically evaluate anti-platelet effect of clopidogrel influenced by CYP2C19*2,*3 polymorphism in patients with cardiovascular diseases, in order to provide references for its safe medication. Meth-ods Literature was retrieved in electronic databases covering EMbase, PubMed, Th e Cochrane Library, CBM and CNKI from establishment dates to November, 2011. Observational studies and clinical trials were included, cross-checked, as-sessed and pooled for meta-analysis. meta-analysis was performed using the soft ware RevMan 5.1. Results A total of 13 articles including 14 trials (n=36 855) were included. Th e results of meta-analysis showed that: a) there was no signifi cant diff erence in the incidences of cardiovascular events between CYP2C19*2,*3 carriers and CYP2C19*1 carriers; b) the risk of stent thrombosis in CYP2C19*2,*3 carriers was signifi cantly higher than that in CYP2C19*1 carriers (P<0.000 1), and the relative risk of CYP2C19*2,*3 carriers increased 92% within one month (P<0.000 1); c) as for bleeding events, there were no signifi cant diff erences between CYP2C19*2,*3 carriers and CYP2C19*1 carriers. Conclusion Compared with CYP2C19*1 carriers, CYP2C19*2,*3 carriers have a higher risk of stent thrombosis in clopidogrel-treated patients, but there are few diff erences in cardiovascular and bleeding events between the two carriers. Th erefore, CYP2C19*2,*3 carri-ers with cardiovascular diseases and ready to receive PCT are suggested to pay more attention to stent thrombosis when using clopidogrel. We propose that patients with cardiovascular diseases and ready to receive PCT should have CYP2C19 tests to determine the use of antiplatelet drug (clopidogrel) to avoid thrombus.

Key words Clopidogrel; Cardiovascular disease; CYP2C19; Genetic polymorphisms; Meta-analysis; Safe medication

基金項(xiàng)目：中國老年人綜合評估和醫(yī)療服務(wù)體系建立及推廣（編號：201002011）△ 系統(tǒng)評價(jià)注冊號：ChiCTR-OCS-12001901作者簡介：楊莉萍，女（1964年～），博士，主任藥師。以臨床藥學(xué)，藥物基因組學(xué)，藥物相互作用，老年合理用藥為主要研究方向。Email: yanglp_2000@*通訊作者，Email: huxinbjyy@

© 2012 中國循證醫(yī)學(xué)雜志編輯部

CJEBM 1063

  本文關(guān)鍵詞：CYP2C19*2、*3基因多態(tài)性與氯吡格雷臨床療效相關(guān)性的系統(tǒng)評價(jià)，由筆耕文化傳播整理發(fā)布。