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种族对克洛皮多格雷尔治疗参与者的血小板反应和临床结果的影响
Luis Ortega-Paz1, Cameron D Thomas2, Claudio Laudani1,3
1Division of Cardiology, University of Florida College of Medicine, Jacksonville, Florida, USA.
Clinical pharmacology and therapeutics
|August 28, 2025
概括
通过皮肤冠状动脉干预 (PCI) 治疗的黑人患者血小板反应性较高,心血管重大不良事件 (MACE) 的风险增加. 与非黑人患者相比,这种情况在出血事件中没有显著差异.
科学领域:
- 心血管医学
- 药理学
- 遗传学
背景情况:
- 与非黑人相比,接受皮肤冠状动脉干预 (PCI) 的黑人患有较高的重大心血管不良事件 (MACE).
- 克洛皮多格勒是PCI后常用的抗血小板药物,但它的有效性可能有所不同.
- 血小板反应性和遗传因素,如CYP2C19变体,可能会影响临床结果.
研究的目的:
- 评估黑人和非黑人用克洛皮多格雷尔治疗患者血小板反应的种族差异.
- 评估PCI后的种族,血小板反应性和1年临床结果之间的关联,包括MACE和出血.
主要方法:
- 分析了两个队列:一个用于血小板功能测试的药理学队列和一个用于临床结果的PCI队列.
- 高血小板反应率 (HPR) 被定义为P2Y12反应单位 (PRU) > 208.
- 主要心血管不良事件 (MACE) 包括心血管死亡,心肌梗塞 (MI),缺血性中风或支架血栓形成. 进行了CYP2C19基因型鉴定.
主要成果:
- 与非黑人参与者相比,黑人参与者呈现出明显更高的PRU水平和更高的HPR流行率 (39.3%对20.6%).
- HPR的独立预测因素包括黑人种族,血红蛋白水平和CYP2C19功能丧失等位基因.
- 在PCI队列中,黑人参与者有更高的1年MACE风险 (HR1. 47),主要是由心脏病 (HR1. 71),在出血风险上没有显著差异.
结论:
- 接受克洛皮多格勒治疗的黑人患者表现出血小板反应性增加和HPR的更高率.
- 这种高反应性与PCI后MACE的风险增加有关,特别是心肌梗塞.
- 这些发现突出了抗血小板治疗反应和结果的潜在种族差异,需要进一步研究个性化治疗策略.
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