Distribution And Correlation Analysis Of CYP2C19 Gene Polymorphism In Patients With ACS And Type 2 Diabetes Mellitus

Acute coronary syndrome(ACS)complicated with diabetes mellitus(DM),as a common,frequently-occurring,high-risk disease.How to individualize and safely treat and evaluate the prognosis of these patients is very important.CYP2Cl9 enzyme is a key enzyme that affects Clopidogrel metabolites as active products.The level of its enzyme metabolism ability is an important part of affecting the efficacy of clopidogrel.This paper studied the distribution of CYP2CI9 gene polymorphism in patients with ACS and type 2 diabetes mellitus(T2DM).Analyze the related factors of CYP2C19 gene polymorphism in order to predict the effect of drug therapy and optimize the treatment.Obj ectiveTo investigate the distribution of CYP2C19 gene polymorphism in patients with ACS and T2DM,analyze the differences of related factors among patients with different CYP2C19 gene metabolism,predict the efficacy of drug use,optimize the treatment plan and guide clinical individualized treatment.MethodsFrom September 2017 to June 2018,200 ACS patients with T2DM were selected from the second affiliated Hospital of Shenyang Medical College-Multiplex fluorescence quantitative PCR probe method was used to detect the gene of ACS patients with T2DM,and the distribution of gene polymorphism was analyzed.Exclude patients with ultrafast metabolic type(*I/*17,*17/*1 7),according to the fast metabolic pattern(?I/?I),the moderate metabolic type(?1/*2,*1/?3,?2/*17,*3/*17),the slow metabolic type(*2/*2,*2/*3,*3/*3),the patients divided into three subgroups.The general baseline data and the differences blood glucose control levels of the three subgroups were compared.The regression analysis of the metabolic type and related factors of CYP2C19 gene was carried out.Results1.A total of 200 patients with ACS complicated with T2DM(100 males and 1 00 females)aged between 35 and 90 years were enrolled in this study.A total of 7 genotypes were expressed,The genotype distribution of CYP2C19 is as follows:CYP2C19*1/?1 37%,CYP2C19*1/?17 0.50%,CYP2CI 9*1/*2 20.50%,CYP2C19*1/*36%,CYP2C19*2/*17 2%,CYP2C19*2/*2 26.50%,CYP2C19*2/*3 7.50%.Wild gene(*1)frequency is 50.50%,mutation gene frequency is 49.50%.Including*2 locus mutation 41.50%,*3 locus mutation 6.75%,*1 7 locus mutations 1.25%.This experiment obeys Hardy-Weinberg 's law(X2=0.01,p>0.05).The genotypic distribution of the studied population has a certain population representation.2.In ACS with T2DM patients,four gene metabolic types were expressed.the proportion of ultra fast metabolic type was 0.50%,the fast metabolic type was 37%,the moderate metabolic type was 28.50%,the ultra slow metabolic type was 34%3.Excluding the ultra-fast metabolic type,the general baseline data among the three subgroup gene metabolic types were compared,and only the difference of LDL level was statistically significant.(p<0.05).4.According to whether the level of HbAlc is over 6.5%or not,it can be divided into two groups:blood sugar control standard and blood sugar control substandard.There is significant difference in HbAlc control level among the three gene metabolic types(X2=6.93,P<0.05).5.The main effect model was used to analyze the multivariate logistics regression with three gene metabolic types of CYP2C19 as dependent variables,the control level of HbAlc and the level of LDL as independent variables.The model was statistically significant(model fitting P<0.05),but only the control level of HbAlc contributed significantly to the composition of the model(likelihood ratio test only HbAlc P<0.05),LDL level did not contribute significantly to the composition of the model.The normal HbAlc was positively correlated with the fast metabolic type of CYP2C1 9,and the gene metabolic type of normal HbAlc was more likely to be fast metabolic type than that of those who did not meet the standard of HbAlc control,which was 2.35 times more likely than that of those who did not meet the standard.Conclusion1.The distribution of CYP2C19 gene polymorphism in patients with ACS complicated with type 2 diabetes mellitus is mainly slow metabolism.Before the application of antiplatelet drugs,the detection of CYP2C19 gene polymorphism is more helpful to guide the use of drugs in clinic.2.Patients with chronic metabolism of CYP2C19 genotype had lower HbAlc compliance rate and more difficult blood glucose control.