Correlation Analysis Between Multiple Drug Use And CYP2C19 Gene Polymorphism On Clopidogrel Resistance

Objective: To determine whether there is a correlation between multiple drug use and CYP2C19 gene polymorphism and Clopidogrel resistance(CR).Methods: Selection in September 2015 to September 2017 first affiliated hospital of China medical university during the heart line with PCI 1000 cases of patients with coronary heart disease,according to include and exclude standard screening standard into the set of objects,the research object of the accord with a standard in accordance with the determination of platelet aggregation function induced method(ADP)> 50% divided into clopidogrel resistance group(CR),the rest of the normal response to clopidogrel group(NCR);The patients were divided into the multi-drug group and the non-multi-drug group according to the type of drug(except the dual-drug).According to the polymorphism of CYP2C19 gene,it can be divided into fast metabolic type(CYP2C19~*1/~*1),medium metabolic type(CYP2C19~*1/~*2,~*1/~*3)and slow metabolic type(CYP2C19~*2/~*2,~*2/~*3,~*3/~*3).Logistic regression analysis was used to investigate whether multiple drug use and CYP2C19 gene polymorphism were risk factors for clopidogrel resistance.Results: Logistic regression analysis was used,and after multivariate correction,the analysis results suggested that: 1.Slow metabolic genotype was an independent risk factor for clopidogrel resistance,that is,patients with slow metabolic type had an increased risk of clopidogrel resistance in those with fast metabolic type.OR and 95%CI were 5.85(1.75,19.56),p=0.004<0.05.;2.There was a trend of resistance to clopidogrel with multiple drugs,but it did not reach statistical significance.OR and 95%CI were 1.79(0.94,3.40),p=0.075>0.05.;3.After further gender stratification,multiple drugs were found to be a risk factor for resistance to clopidogrel in the female population.OR and95%CI were 4.80(1.20,19.27),p=0.027<0.05.;4.In the male population,there is an association between the slow metabolic genotype and clopidogrel resistance.OR and95%CI were 5.85(1.75,19.56),p=0.004<0.05.Conclusion: The genotype of slow metabolism was an independent risk factor for clopidogrel resistance,and multiple drugs tended to cause clopidogrel resistance(p=0.075).Men with slow-metabolic genotypes were more likely to develop clopidogrel resistance,while women with multiple drugs were more likely to develop clopidogrel resistance.