基因型CYP2C19与接受皮冠状动脉干预治疗的黑人患者的不良心血管结果有关
Kayla R Tunehag1, Cameron D Thomas2, Francesco Franchi3
1Division of Pharmacotherapy and Experimental Therapeutics, Eshelman School of Pharmacy University of North Carolina at Chapel Hill Chapel Hill NC USA.
黑人患者具有较差的CYP2C19代谢器基因型,在PCI后接受克洛皮多格雷尔治疗时面临更高的心血管风险. 各组出血风险相似,这表明可能需要使用替代的抗血小板策略.
科学领域:
- 心脏病学 心脏病学
- 药物基因组学 药物基因组学
- 临床研究 临床研究
背景情况:
- 细胞染色体P450 2C19 (CYP2C19) 中介和低代谢剂在PCI后降低了克洛皮多格雷尔的有效性.
- 现有的研究缺乏种族多样性,不清楚对黑人患者的影响.
研究的目的:
- 为了研究CYP2C19基因型和心血管结果之间的关联,在PCI后接受克洛皮多格雷尔治疗的黑人患者中.
- 解决了解药物基因组对不同人群的影响的差距.
主要方法:
- 对567名接受PCI和CYP2C19基因定型的黑人患者的回顾性分析.
- 在PCI后1年内主要动脉血和出血事件发生率的比较,跨CYP2C19代谢组.
- 多变量考克斯回归调整以考虑混因素.
主要成果:
- 与其他 (9.7%) 相比,中等和差代谢者 (19.2%) 的主要动脉血事件显著高于其他 (9.7%).
- 对不良事件的调整后危险比为2.00 (95% CI,1.20-3.33) 在低/中等代谢者中.
- 出血事件的发生率很低 (4.1%),并且在不同组之间没有显著差异.
结论:
- 接受克洛皮多格雷尔治疗的黑人患者具有CYP2C19中间/差代谢器表型,在PCI后心血管不良结果的风险增加.
- 出血风险需要谨慎解释;需要进一步的研究.
- 需要进行前性研究,评估基因型导向的普拉苏格勒或提卡格勒在这个人群中的使用情况.
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