Association Of CYP2C19 Gene Polymorphism With Clopidogrel Antiplatelet Effect

Objective:Antiplatelet therapy is one of the most effective means to prevent acute cardiovascular events in coronary heart disease,and clopidogrel is the first-line drug in the field of oral antiplatelet therapy.Clopidogrel is an inhibitor of P2Y12 receptor and plays an important role in the prevention of ischemic events in patients with acute coronary artery syndrome(ACS).But clinical studies have demonstrated that there were individual differences in the response to clopidogrel.A variety of factors were contribute to the chloropidogrel response,and the genes that affect the metabolism of clopidogrel play an significant role in the process.The gene CYP2C19 polymorphism has been identified as the key factor of influence clopidogrel responsiveness,there are experiments show CYP2C19 gene polymorphisms with clopidogrel therapy clinical relationship between reactivity.The loss of function CYP2C19 gene is prevalent in Asian.So it’s necessary to estimate their CYP2C19 gene this experiment explored the the distribution of lose of function type CYP2C19 gene in patients with ACS,and its clinic outcomes after clopidogrel treatmentMethod:Fifty patients with ACS were enrolled in our hospital from May to December in 2016.The CYP2C19 genotype was detected by venous blood.According to whether the CYP2C19 loss allele was divided into two groups,one group was non-carrier and the other(CYP2C19*2 and CYP2C19*3)were carrier.The two groups were treated with clopidogrel and two weeks later,we collected these indexes:chest pain,the rate of remission,the incidence of cardiovascular events,and the rate of bleeding.The data were analyzed by SPSS 17.0 statistical software.The data were expressed as(n/%),and the difference was statistically significant by P<0.05.Results:A total of 50 ACS patients were included in the study,including 29 males and 21 females;the mean age of the carrying group was 64.2 + 7.83 years and the mean age of the non-carrying group was 65.2 ± 7.05 years.66%of the patients carried at least one functional deletion gene(CYP2C19*2 or CYP2C19*3),genotype distribution consistent with Hardy-Weinberg genetic balance(P>0.05),of which 54%of patients carrying at least one CYP2C19*2.CYP2C19*2 and CYP2C19*3 were 29%and 6%,respectively.There were 4 cases(12%)of chronic metabolic(PM)and 29(87.8%)of metabolic(IM).The rate of chest pain remission was 23 cases(52.2%)in the patients after oral administration of clopidogrel,including 21 patients(72.4%)in the other metabolic patients and 15 patients(88.2%)in the non-carrying group.The response rate was low,and p<0.05,was statistically significant.The reduction rate of nitroglycerin in the two groups was 66%in the carrying group and 94%in the non-carrying group,p<0.05,which was statistically significant.Two cases of subcutaneous hemorrhage and gastrointestinal bleeding were non-carrying group 1 case(5%),carrying group 2 cases(6%),chi-square test showed P = 0.068,the difference was not statistically significant.There were no serious adverse events and cerebrovascular accident in both groups.Conclusion:CYP2C19 inactivating genes(CYP2C19*2 and CYP2C19 a9 3)were significantly higher in ACS patients,especially CYP2C19*2,with anti-platelet reactivity of clopidogrel in patients with CYP2C19 inactivated gene,suggesting that Higher cardiovascular risk.