Relationship between clopidogrel responsiveness and CYP2C19 genotype by thromboelastography in patients with coronary heart disease after PCI
10.13303/j.cjbt.issn.1004-549x.2022.05.006
- VernacularTitle:血栓弹力图检测冠心病患者PCI术后对氯吡格雷反应性与CYP2C19基因型的关系分析
- Author:
Feihuan HU
1
;
Heng YANG
2
;
Pushan ZHANG
1
;
Ximing LI
1
;
Hanshen YE
1
Author Information
1. Department of Blood Transfusion, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
2. Department of Blood Transfusion, Zhujiang Hospital of Southern Medical University
- Publication Type:Journal Article
- Keywords:
thromboelastography(TEG);
CYP2C19 genotype;
clopidogrel responsiveness;
coronary heart disease
- From:
Chinese Journal of Blood Transfusion
2022;35(5):500-503
- CountryChina
- Language:Chinese
-
Abstract:
【Objective】 To explore the relationship between clopidogrel responsiveness and CYP2C19 gene polymorphism by thromboelastography(TEG) after PCI in patients with coronary heart disease, and its guiding significance for the use of clopidogrel after PCI. 【Methods】 A total of 246 patients who underwent PCI surgery in our hospital from June 2018 to May 2021 and routinely took clopidogrel maintenance treatment after the operation were selected.The platelet inhibition rate of the patients was detected by TEG to obtain their response to clopidogrel.The CYP2C19 genotype was detected, and the relationship between the patient′s responsiveness to clopidogrel and the CYP2C19 genotype was analyzed. 【Results】 The CYP2C19 genotypes in 246 patients were fast metabolizer (n=95), intermediate metabolizer (n=104) and slow metabolizer (n=47), with the mean ADP inhibition rate(%) at 46.27±21.41, 40.99±25.53 and 24.77±21.68, respectively.They were divided into clopidogrel resistant group (n=98) and clopidogrel normal response group (n=148). The three groups of patients with different CYP2C19 genotypes had no statistically significant differences in gender composition, age and platelet count (P>0.05), while significant differences in hypertension, diabetes and hyperlipidemia(P<0.05). Further comparison of the responsiveness to clopidogrel by groups of genotypes showed that there was no statistical difference in the incidence of CR in patients with fast metabolizers and intermediate metabolizers (P>0.05), but they were all lower than those with slow metabolism patients (both P<0.05). The ROC curve was drawn by the ADP inhibition rate measured by TEG and the CYP2C19 genotype, and the area under the curve (AUC) was 0.730(>0.5). Statistically significant difference was noticed in the low responsiveness to clopidogrel by different CYP2C19 genotypes (P<0.05). The drug responsiveness of clopidogrel measured by TEG had strong correlation with the patient′s CYP2C19 genotype.When the ADP inhibition rate was the best cut-off value (27.10%), the sensitivity and specificity of CYP2C19 genotype being diagnosed as the slow metabolite type, was 73.37% and 70.21%, respectively. 【Conclusion】 The response of clopidogrel after PCI in patients with coronary heart disease is associated with CYP2C19 genotype polymorphism.The use of TEG to detect the ADP inhibition rate of patients has strong predictive effect on CYP2C19 genotype and has guiding significance on antiplatelet therapy in patients with coronary heart disease after PCI.
