Analysis Of CYP2C19 Gene Polymorphism And Its Anti-platelet Therapy In Patients With Coronary Heart Disease In Hainan Han And Li Ethnic Group

objective:1.To investigate the distribution of cytochrome P450 2C19(CYP2C19)allele,genotype and metabolic profile in patients with coronary heart disease of Li and Han nationality,and to explore its clinical significance.2.Comparison of CYP2C19 gene polymorphism between those age less than 65 years and above in patients with coronary heart disease.3.To observe the clinical efficacy of clopidogrel and ticagrelor in the treatment of patients who suffer from coronary heart disease with CYP2C19 gene non-fast metabolic profile.methods:1.286 cases of unrelated patients with coronary artery disease,Including 111 cases of Li nationality and Han nationality of 175 cases,were selected,the CYP2C19 * 1,* 2,* 3 alleles were detected by DNA microarray chip method,and the CYP2C19 allele,genotype and metabolic distribution were analyzed.Comparisons of two different ages(aged 65 or over,and < 65)in gene polymorphism were made.2.Non-fast metabolic patients were identified according to the CYP2C19 genotyping were Follow-up and treated with double antiplatelet therapy for at least 12 months,patients were randomly divided into clopidogrel group(clopidogrel 75 mg qd + aspirin 100 mg qd)and ticagrelor group(ticagrelor 90 mg bid + aspirin 100 mg qd).Result:1.Compared with the Han,Li allele of *1 significantly increased(56.86%,67.12%,P<0.05),* 2 was significantly reduced(32.00%,23.87%,P<0.05);Wild genotype * 1 / * 1,rapid metabolic type was significantly increased(34.86%,46.85%,P<0.05);there was no significant difference between the allele * 3,the intermediate metabolic and the slow metabolic type.Genotype * 3 / * 3 was not found in the selected cases,suggesting that the allele * 3 had a very low double mutation rate.2.There were no significant differences in alleles,genotypes and metabolic profiles between ?65 years old and <65 years old group(P> 0.05).3.Followed up for 12 months,in the CYP2C19 gene showed intermediate metabolism,slow metabolism in patients with coronary heart disease,In the CYP2C19 intermediate metabolic and slow metabolic coronary heart disease patients,Compared with clopidogrel group,the incidence of recurrence of ACS,recurrent PCI and stent thrombosis were significantly decreased in the ticagrelor group,the difference was statistically significant,rate of cardiovascular death,severe bleeding,mild bleeding in the two groups no significant difference.Conclusion:There were significant differences in the distribution of cytochrome P450 2C19 gene between pure racial Li and Han patients with coronary heart disease,and the mutation rate does not increase with age.ticagrelor can reduce the incidence of adverse cardiovascular events in the CYP2C19 gene metabolic and slow metabolic population and did not increase the risk of clinical bleeding.It is important for patients with clinically optimized antiplatelet therapy.