Study On Clopidogrel Drug Reactivity And CYP2C19 Gene Polymorphism In Patients With Coronary Heart Disease

Objective To explore the distribution of cytochrome P450 CYP2C19 gene polymorphism in population of Qingdao, and study the use of thrombelastography(Thrombelastography, TEG) in monitoring of clopidogrel antiplatelet effect and analyze the relastionship between clopidogrel resistance and gene polymorphisms of CYP2C19.Methods 416 cases of coronary heart disease patients were selected who received PCI in Affiliated Hospital of Qingdao University during the periods from November 2014 to October 2015. The patients were divided into CR group(88 cases) and effective group(324 cases) based on the response of patient to antiplatelet effect of clopidogrel and pyrosequencing was used to detect CYP2C19 genotype. Compare the general clinical data in each group, and analyzed the CYP2C19 polymorphism and the mechanism underlying the difference of response to anti-platelet treatment.Results The ADP inhibition rate <30% of patients with clopidogrel resistance occurred in 88 cases(21.15%) of 416 patients, the ADP inhibition rate ?30% of clopidogrel in patients with onset of 328 cases(78.85%). Diabetes, hyperlipidemia in clopidogrel resistance group were accounted for 32.95%, 61.36%, clopidogrel onset group accounted for 25%, respectively, 28.66%, is a poor response to clopidogrel in patients with risk factors. CYP2C19 gene wild type, heterozygous mutant and homozygous mutant gene carriers clopidogrel resistance rates were 16.98%, 20.19%, 38.76%, Patients with homozygous mutant gene have a high incidence of CR compared with patients with wild-type and heterozygous mutant CYP2C19 genotype.Conclusion Thrombelastography test ADP inhibition rate reflects the antiplatelet effect of clopidogrel. Diabetes and hyperlipidemia are risk factors for the incidence of CR. CYP2C19 gene polymorphism is a genetic risk factor for CR. Its loss of function of the gene mutation is associated with CR, which is genetic susceptibility factors of CR.