| Objective: In this study,clopidogrel genotype and thromboelastography(TEG)were detected in patients with acute coronary syndrome(ACS)after PCI,and the inhibition of platelet aggregation induced by ADP by clopidogrel genotype polymorphism was analyzed The influence of aggregation(IPA)and the correlation between them were discussed.(2)whether the individualized antiplatelet therapy could be made according to gene detection.Method: From August 2018 to November 2019,100 patients who were diagnosed as Acute coronary syndrome(ACS)with concurrent PCI in the First Subsidiary Hospital of Wannan Medical College were selected as the study subjects.(1)CYP2C19(g681a and c-806t)and ABCB1(C3435T)were detected in 100 patients with ACS.PCR restriction fragment length polymorphism was used to genotype clopidogrel.Then,according to CYP2C19 loss of function(CYP2C19 * 2)and CYP2C19 * 17 allele(clopidogrel allele,CA),ABCB1 and PON 1 alleles were classified as fast metabolized,intermediate metabolized and slow metabolized;(2)IPA was detected by adenosine diphosphate with TEG method;ACS patients were divided into normal group and resistant group according to IPA results,and the relationship between the genotypes and IPA inhibition rate was compared;(3)clopidogrel 75 mg was continued to be orally administered to normal group QD and aspirin 100 mg QD combined antiplatelet drug therapy.Patients in hyporesponsiveness group were treated with 90 mg bid and100 mg QD of ticagrelor.(4)According to the genotype and TEG test results,weadjusted the drug in the resistance group,reviewed and followed up the efficacy in a short period of time,and observed the incidence of MACE Events(including recurrent angina,myocardial infarction,stent thrombosis and cardiovascular death)and bleeding events(including eye,nose,gingival skin,brain,gastrointestinal tract and urinary system bleeding).Results:(1)Results there were 43(43%)cases of CYP2C19 fast metabolism(* 1 / * 1,EM),42(42%)cases of intermediate metabolism(* 1 / * 2,* 1 / * 3,* 2 / * 17,* 3 / *17,IM),and 15(15%)cases of slow metabolism(* 2 / * 2,* 2 / * 3,* 3 / * 3,PM).Clopidogrel resistance was found in all metabolic types.The percentage of clopidogrel resistance in EM,Im and PM genotypes was 3(7%),6(14.3%),5(33.3%),and the inhibition rate of ADP was(60.33 ± 22.85)%,(59.13 ± 25.75)% and(51.91 ±33.60)% respectively,The incidence of Cr in PM genotype was significantly higher than that in other two genotypes;among the ABCB1 genotypes of clopidogrel,87 were wild-type and 13 were mutant;among the PON1 genotypes,38 were wild-type and 62 were mutant.There was no significant difference between the two genotypes in Cr(P > 0.05),considering that ABCB1 and PON1 had little effect on Cr;(2)According to CYP2C19 genotype,antiplatelet drugs were adjusted in 14 CR patients.Compared with EM and IM,the relationship between PM and IPA was more significant(P < 0.05);in the general condition of patients,gender,uric acid and triglyceride levels were correlated with CR,which was statistically significant(P <0.05);3.After 6 months of follow-up,1 case of stent restenosis and 4 cases of gastrointestinal bleeding occurred.Conclusion:(1)There was a significant correlation between the polymorphism of clopidogrel gene and IPA;the reactivity of clopidogrel platelets was mainly affected by CYP2C19 gene polymorphism;(2)the incidence of Cr in patients with slow metabolism(PM)was significantly higher than that in patients with fast metabolism(EM)and intermediate metabolism(IM),For ACS patients with drug-eluting stents,the presence of clopidogrel alleles is the influencing factor of high platelet reactivity in the treatment of clopidogrel;(3)this study suggests that clinicians should adjust the antiplatelet treatment strategy according to the genotype and IPA,and patients may benefit. |
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