| Objective:(1)This study used clopidogrel gene detection to observe the genotype of patients with unstable angina pectoris(UAP)treated with Percutaneous Coronary Stent Implantation(PCI);(2)Simultaneously,thrombelastography(TEG)was used to observe the inhibitory function of platelets;(3)to compare the correlation between clopidogrel genotype and platelet inhibition function;(4)to further develop individualized antiplatelet therapy,Short-term follow-up was performed to observe the incidence of Major Advers Cardiovascular Events(MACE)and bleeding events in patients with UAP after PCI.Method: This study included 100 patients with UAP who underwent PCI in the Department of Cardiology,the First Affiliated Hospital of Wannan Medical College from August 2017 to August 2018,and who received clopidogrel and aspirin after surgery.(1)CYP2C19* 2(681G>A),CYP2C19* 3(636G>A),CYP2C19* 17(806C>T),ABCB1(3435C>T)and PON1(576G> were determined by fluorescence staining in situ hybridization analysis.A)genotype;(2)detection of platelet inhibition by TEG;(3)classification of patients into clopidogrel resistance(CR)group and non-clopidogrel resistance(Non-clopidogrel resistance,according to TEG test results)NCR)group,compare the correlation between genotypes and platelet inhibition rate and influencing factors;(4)combined with genotype and TEG test results to guide clinical adjustment of treatment plan,patients were followed up for 6 months,observe patients MACE(heart The incidence of vascular death,stent restenosis,stroke,recurrent unstable angina,and bleeding events.Results:(1)This study found that CYP2C19 has three phenotypes: fast metabolism(RM),intermediate metabolism(IM)and slow metabolism(PM).There are 64 mutated genotypes of IM and PM,respectively.In 13 cases,there were 36 normal RM genotypes;63 cases of ABCB1 and PON1 genes carrying mutation genes;(2)31 cases(31%)in CR group and 69 cases(69% in NCR group)There were 11 cases,8 cases and 12 cases of CR in CYP2C19 RM,IM and PM patients respectively;23 cases and 31 cases of CR in ABCB1 and PON1 mutant genotypes respectively;(3)CYP2C19 RM,The platelet inhibition rates of IM and PM patients were(54.93±28.90)%,(57.62±25.95)%,and(19.80±10.94)%,respectively.The platelet inhibition rate between IM and PM was statistically significant(P<0.05).There was no significant difference between ABCB1 and PON1 and platelet inhibition rate(P>0.05).According to CYP2C19 genotype and TEG results,31 patients were adjusted for clopidogrel,including 11 cases with RM and 8 cases with IM.There were 12 cases of PM.Compared with RM and IM,there was a higher correlation between PM and platelet inhibition rate,and the difference was statistically significant(P<0.05).In general clinical data,two groups were compared.Platelet count,single vessel disease and double vessel disease were statistically significant(P<0.05);(4)6 months follow-up,2 stent restenosis and 3 bleeding events(cerebral hemorrhage,One case of hemoptysis and gastrointestinal bleeding),one of them showed in-stent restenosis after adjustment,and 5 cases were CYP2C19 IM.There was no significant difference between the two groups(P>0.05).Conclusion:(1)There is a significant correlation between CYP2C19 PM and platelet inhibition rate,suggesting that clinicians can adjust the clopidogrel according to the clopidogrel genotype(PM)test results to make UAP patients benefit more after PCI.(2)In the CYP2C19 IM gene phenotype,the incidence of clinical adverse events in patients with normal platelet inhibition rate and no adjustment for clopidogrel increased,suggesting that clinicians should adjust the drug regimen according to the results of genetic testing. |
PDF Full Text Request