Abstract:

Objective　To explore the distribution characteristics of ABCB1, PON1, and CYP2C19 genotypes in patients with coronary heart disease in Mengyin area and their clinical significance of guiding precise drug use after percutaneous coronary intervention (PCI). Methods　It was a clinical trial. A total of 785 patients with coronary heart disease who were diagnosed and treated in Mengyin County People's Hospital from May 2019 to October 2021 were selected consecutively. The genotype detection was performed for all the patients, and the distribution characteristics of genotype were statistically analyzed. The patients requiring PCI were divided into a normal metabolism group (183 cases) and a slow metabolism group (115 cases) according to the genotype detection results. In the normal metabolism group, 129 males and 54 females, aged 63.0 (53.3, 70.0) years, took clopidogrel 75 mg/d after surgery. In the slow metabolism group, 88 males and 27 females, aged 64.0 (54.0, 70.0) years, took ticagrelor 90 mg/time, twice a day or cilostazol 100 mg/time, twice a day. The two groups both took aspirin 100 mg/d, and other drugs were selected according to the conditions. The main adverse cardiovascular events were followed up within 12 months after operation and were compared between the two groups. Rank sum test and χ² test were used. Results　In the patients, the mutation frequency of ABCB1 gene was 61.14% (480/785); the mutation frequency of PON1 gene was 67.64% (531/785); CYP2C19 fast metabolism genotype accounted for 40.89% (321/785), ultra-fast metabolism genotype accounted for 0.89% (7/785), intermediate metabolism genotype accounted for 43.82% (344/785), and slow metabolism genotype accounted for 14.39% (113/785). The frequency of clopidogrel absorption and metabolism-related gene mutation was higher in patients with coronary heart disease in this region. There was no statistically significant difference in the incidence of adverse events between the patients in the slow metabolism group after precision medication and the normal metabolism group [13.91% (16/115) vs. 9.84% (18/183)] (P>0.05). Conclusion　The mutation rate of clopidogrel absorption and metabolism-related genes is high in patients with coronary heart disease in Mengyin area, and it is of important clinical significance to accurately use drugs after PCI according to the genotypes.

Key words:

Coronary heart disease, Genotype, ABCB1, PON1, CYP2C19, Precise medication

摘要：

目的　探究蒙阴地区冠心病患者ABCB1、PON1、CYP2C19基因型分布特点及指导经皮冠状动脉介入（PCI）术后精准用药的临床意义。方法　本文为临床试验性研究，选取2019年5月至2021年10月在蒙阴县人民医院诊治的785例冠心病患者，均行基因型检测，对基因型的分布特征进行统计分析。依据基因型结果对需要行PCI术的患者分为正常代谢型组（183例）和慢代谢型组（115例）。正常代谢型组男129例、女54例，年龄63.0（53.3，70.0）岁，术后服用氯吡格雷75 mg/d；慢代谢型组男88例、女27例，年龄64.0（54.0，70.0）岁，术后服用替格瑞洛90 mg/次、2次/d或西洛他唑100 mg/次、2次/d，以上两组均联合服用阿司匹林100 mg/d，根据病情选择服用其他药物。于术后12个月内随访和比较两组主要心血管不良事件发生情况。采用秩和检验、χ²检验。结果　入选患者中ABCB1基因突变频率为61.14%（480/785）；PON1基因突变频率为67.64%（531/785）；CYP2C19快代谢基因型占40.89%（321/785），超快代谢基因型占0.89%（7/785），中间代谢基因型占43.82%（344/785），慢代谢基因型占14.39%（113/785）。本地区冠心病患者的氯吡格雷吸收与代谢相关基因突变频率较高。慢代谢型组患者精准用药后与正常代谢型组不良事件发生率比较，差异无统计学意义［13.91%（16/115）比9.84%（18/183）］（P>0.05）。结论　蒙阴地区冠心病患者氯吡格雷吸收与代谢相关基因突变率较高，依据基因型指导PCI术后精准用药具有重要临床意义。

关键词:

冠心病, 基因型, ABCB1, PON1, CYP2C19, 精准用药