| Objective: In this study,clopidogrel genotype and the inhibition of platelet aggregation(IPA)were detected for patients with Coronary heart disease(CHD)after PCI,and the correlation between them was discussed so as to provid guidance on the choice of antiplatelet agents for patients after PCI and reference for clinicians to make individualized treatment plan with genetic testing and platelet function detection,improve the prognosis of patients and reduce the waste of medical resources.Methods: This retrospective study was selected 182 CHD patients who successfully received PCI from January 2018 to August 2020 in The First Subsidiary Hospital of Wan nan Medical College as the study subjects,clopidogrel genotype and IPA were detected in everyone.(1)patients were divided into normal group(IPA<30%)and hyporesponsiveness group(IPA≥30%)according to the IPA results which were induced by ADP.(2)CYP2C19、ABCB1、 PON1 were detected in 182 patients after PCI.Fluorescence staining in situ hybridization was used to genotype clopidogrel.Then,according to CYP2C19 loss of function allele(CYP2C19 * 2、CYP2C19 * 3)and gain of function allele(CYP2C19 * 17),they were classified as ultra-rapid metabolizer,express metabolized,intermediate metabolized and poor metabolized.(3)The normal group received clopidogrel 75 mg QD and aspirin 100 mg QD combined with antiplatelet agents.Hyporesponsiveness group was given ticagrelor 90 mg bid and 100 mg QD.(4)Reviewed the incidence of MACE events(including recurrent angina,myocardial infarction,stent thrombosis,stroke and cardiovascular death)and bleeding events.Results:(1)There were 3(1.65%)cases of CYP2C19 ultra-rapid metabolizer,70(38.46%)cases of CYP2C19 express metabolism(* 1 / * 1,EM),85(46.7%)cases of intermediate metabolism(* 1 / * 2,* 1 / * 3,* 2 / * 17,* 3 / * 17,IM),and 24(13.19%)cases of poor metabolism(* 2 / * 2,* 2 / * 3,* 3 / * 3,PM).(2)Clopidogrel resistance was found in all metabolic types.The inhibition rate induced by ADP in UM,EM,IM and PM was(40.27±36.11)%、(63.17±24.46)%、(58.29±29.31)%、(42.13±27.93)% respectively and was more significant(P < 0.05),compared the IPA between them,PM’s were significantly lower(P < 0.05).(3)Among the ABCB1 genotypes of clopidogrel,147 were wild-type and 35 were mutant.The IPA by ADP in wild-type and mutant was(57.32 ± 28.63)% and(59.53 ± 26.05)%.There was no significant difference between the two genotypes in IPA(P > 0.05).Among the PON1 genotypes,128 were wild-type and 54 were mutant.the IPA in wild-type and mutant was(57.05 ± 28.56)% and(59.38± 27.14)%.There was no significant difference between the two genotypes in IPA(P >0.05),suggesting that ABCB1 and PON1 genotypes had little influence on clopidogrel reactivity.(4)The normal group was 147 patients and hyporesponsiveness group was 35 patients.The percentage of low clopidogrel response in UM,EM,Im and PM genotypes was 1(33.3%),5(7.14%),17(20%),12(50%),and the proportions of each metabolic type were significantly different(P < 0.01).The incidence of low clopidogrel response in PM genotype was significantly higher than that in other three genotypes.(5)There was no significant difference between the two groups in general clinical data,such as diabetes,smoking and gender,none of whom were correlated with IPA(P>0.05).(6)0 case of stroke;1 case of stent restenosis;17 cases of recurrent angina;4 cases of heart failure and 4 cases of bleeding(all of them were EM)were occurred within 6 months after PCI.Conclusion:(1)Chinese population has a high mutation rate of CYP2C19 gene,and there was a correlation between PM typing and IPA,so patients with PM may consider replacement therapy.(2)Bleeding events occurred mainly in patients with EM,and more powerful antiplatelet agents may need to be used with caution.(3)Clinicians can adjust the antiplatelet therapy after PCI according to the genotype and IPA to improve the prognosis of patients. |
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