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·药物与临床·

新疆维吾尔族ACS患者CYP2C19基因多态性与氯吡格雷抗血小

板反应性的相关性研究 Δ

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李治纲 ，韩彩平 ，郑丽丽 ，史迎新 ，古再丽努尔·阿卜杜柯尤木 ，刘珊珊 （1.喀什地区第二人民医院药学部，
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新疆 喀什 844000；2.新疆医科大学附属中医医院药学部，乌鲁木齐 830001）
中图分类号 R541.4；R973 .2 文献标志码 A 文章编号 1001-0408（2020）15-1887-05
+
DOI 10.6039/j.issn.1001-0408.2020.15.16
摘 要 目的：探讨新疆维吾尔族急性冠脉综合征（ACS）患者 CYP2C19 基因多态性与氯吡格雷抗血小板反应性的相关性。方
法：选取2018年1月－2019年1月新疆喀什地区第二人民医院心血管内科收治的维吾尔族ACS患者90例，予阿司匹林+氯吡格雷
双联抗血小板治疗且出院后持续用药1年。检测患者血小板聚集抑制率（DPAI），评价其对氯吡格雷的反应性。采用聚合酶链式
反应（PCR）-荧光探针法检测其 CYP2C19*2、*3 基因分型，采用 PCR-直接测序法检测其 CYP2C19*17 基因分型。采用多因素
Logistic回归分析探讨基因和非基因因素与患者DPAI的相关性。结果：90例患者中，氯吡格雷抵抗（CR）的患者有10例，非CR患
者有80例。CYP2C19*2 G/G、G/A、A/A型患者分别有58、28、4例，CYP2C19*3 G/G、G/A型患者分别有88、2例，CYP2C19*17 C/C、
C/T型患者分别有64、26例，各基因型频率均符合Hardy-Weinberg平衡（P＞0.05）。治疗后，CYP2C19*2 G/A、A/A型患者DAPI均
较G/G型患者显著降低，且A/A型患者DAPI显著低于G/A型患者（P＜0.05）；CYP2C19*17 C/T型患者DAPI较C/C型患者显著升
高（P＜0.05）；而 CYP2C19*3 G/A 与 A/A 型患者 DAPI 比较差异无统计学意义（P＞0.05）。多因素 Logistic 回归分析结果显示，
CYP2C19基因多态性与新疆维吾尔族ACS患者DPAI独立相关[比值比＝2.314，95％置信区间（1.569，3.144），P＝0.009]，而年龄、
性别、吸烟等非基因因素与DPAI无关（P＞0.05）。结论：CYP2C19基因多态性与新疆维吾尔族ACS患者氯吡格雷抗血小板反应
性有关，*2野生型患者可能具有更高的DPAI，而*17野生型患者可能具有更低的DPAI。
关键词 氯吡格雷；CYP2C19；基因多态性；血小板聚集抑制率；急性冠脉综合征；维吾尔族

Study on the Correlation between CYP2C19 Gene Polymorphisms and Antiplatelet Reactivity of
Clopidogrel in Xinjiang Uygur Patients with Acute Coronary Syndrome
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LI Zhigang ，HAN Caiping ，ZHENG Lili ，SHI Yingxin ，Guzailinuer·abudukeyoumu ，LIU Shanshan（1. Dept. of
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Pharmacy，Kashi Second People’s Hospital，Xinjiang Kashi 844000，China；2. Dept. of Pharmacy，the
Affiliated TCM Hospital of Xinjiang Medical University，Urumqi 830001，China）
ABSTRACT OBJECTIVE：To investigate the correlation between CYP2C19 gene polymorphisms and antiplatelet reactivity of
clopidogrel in Xinjiang Uygur patients with acute coronary syndrome（ACS）. METHODS：Totally 90 Uygur patients with ACS
who were admitted to the cardiovascular department of Xinjiang Kashi Second People’s Hospital from Jan. 2018 to Jan. 2019 were
selected as the study subjects. They were given anti-platelet therapy of asprin+clopidogrel，and received the treatment continuously
for one year after discharge. The platelet aggregation inhibition（DPAI）rate of the patients were determined，and the response to
clopidogrel was evaluated. PCR-fluorescence probe method was used to detect genotype of CYP2C19*2 and *3，and PCR-direct
sequencing method was used to detect genotype of *17. Multivariate Logistic regression analysis was adopted to investigate the
correlation of gene and non-gene factors with DPAI of patients. RESULTS：Among 90 patients，there were 10 patients with
clopidogrel resistance（CR）and 80 patients with non-CR. There were 58，28 and 4 patients with CYP2C19*2 G/G，G/A，A/A
genotype，respectively；there were 88 and 2 patients with CYP2C19*3 G/G，G/A genotype，respectively；there were 64 and 26
patients with CYP2C19*17 C/C，C/T genotype，respectively；the genotype frequency of each genotype was consistent with
Hardy-Weinberg equilibrium（P＞0.05）. After treatment，DAPIs of patients with CYP2C19*2 G/A，A/A genotype were decreased
significantly，while those of the patients with A/A genotype were significantly lower than patients with G/A genotype patients（P＜
0.05）. DAPIs of patients with CYP2C19*17 C/T genotype
Δ 项目基金：新疆维吾尔自治区自然科学基金资助项目（No.
were increased significantly， compared with C/C genotype
2016D01C087）
patients （P＜0.05）. There was no statistical significance in
＊副主任药师，硕士。研究方向：临床药学。E-mail：15211030080
@fudan.edu.cn DAPIs between CYP2C19*3 G/A and A/A genotype patients
# 通信作者：副主任药师，硕士。研究方向：药理学。E-mail： （P＞0.05）. Multivariate Logistic regression analysis showed
85775264@qq.com that CYP2C19 gene polymorphism was independently related

中国药房 2020年第31卷第15期 China Pharmacy 2020 Vol. 31 No. 15 ·1887 ·