临床药师基于CYP2C19基因检测指导氯吡格雷个体化用药及其疗效评价

doi:10.12092/j.issn.1009-2501.2019.08.015

中国临床药理学与治疗学 ›› 2019, Vol. 24 ›› Issue (8): 938-943.doi: 10.12092/j.issn.1009-2501.2019.08.015

临床药师基于CYP2C19基因检测指导氯吡格雷个体化用药及其疗效评价

杨瑞^1,2，刘慧¹，陈泽姮¹，戚听听¹，张赞玲^1,2，屈强^1,2

¹中南大学湘雅医院药学部，长沙 410008，湖南；²中南大学湘雅医院国家老年疾病临床医学研究中心-老年合理用药与安全用药研究室，长沙 410008，湖南

收稿日期:2019-03-07 修回日期:2019-07-15 出版日期:2019-08-26 发布日期:2019-08-30
作者简介:杨瑞，女，硕士，研究方向：临床药学。 Tel:0731-84327460 E-mail:yangrui198807@163.com
基金资助:
国家自然科学基金（81503166；81603208）；湖南省自然科学基金（2018JJ3846）

Clinical pharmacists use CYP2C19 genotyping test to guide individual medication therapy of Clopidogrel and to evaluate the efficacy of treatment

YANG Rui ^1,2, LIU Hui ¹, CHEN Zeheng ¹, QI Tingting ¹，ZHANG Zanling ^1,2, QU Qiang ^1,2

¹Department of Pharmacy, Xiangya Hospital, Central South Univesty, Changsha 410008, Hunan, China; ² Institute for Rational and Safe Medication Practices, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha 410008, Hunan, China

Received:2019-03-07 Revised:2019-07-15 Online:2019-08-26 Published:2019-08-30

摘要/Abstract

摘要：

目的:探讨临床药师利用CYP2C19基因多态性检测指导患者氯吡格雷个体化用药的意义，并进一步讨论中慢代谢型患者不同治疗方案之间疗效差异。方法:选取本院2016年11月至2017年12月，根据入排标准进行CYP2C19基因检测的患者，临床药师根据基因类型为患者制订个体化用药建议。对于快代谢型患者，建议继续使用氯吡格雷治疗；对于中慢代谢型患者，建议换用其他抗血小板药物治疗。出院12个月后对其进行随访，对比接受临床药师建议换用其他抗血小板药物组和未接受临床药师建议维持原方案使用氯吡格雷组，两组之间疗效是否有差异。结果:在符合纳入和排除标准的200例患者中，基因检测结果显示，快代谢型患者83例，占41.50%；中代谢型患者74例，占37.00%；慢代谢型患者43例，占21.50%。临床药师根据基因检测结果，对患者制订个体化抗血小板治疗用药建议，200例患者中有124例患者采纳临床药师建议，总体采纳率为62.00%。其中，快代谢型患者临床药师意见均被采纳，而中慢代谢型患者临床药师意见采纳率仅为35.04%。12个月之后对117例中慢代谢型患者进行随访，失访23例，最终随访的接受临床药师建议换用其他抗血小板药物组（n=32）与维持原方案使用氯吡格雷组（n=62），两组之间不良心脑血管事件复发率无统计学差异（P＞0.05）。结论:临床药师基于CYP2C19基因检测可以指导氯吡格雷个体化用药；对于中慢代谢型患者，替换其他抗血小板药物治疗并未降低不良心脑血管事件复发风险。

关键词: 氯吡格雷, CYP2C19基因检测, 临床药师, 个体化用药, 抗血小板治疗

Abstract:

AIM: To investigate the significance of clinical pharmacists using CYP2C19 gene polymorphism to guide patients with clopidogrel individualized medication and to further explore the difference in therapeutic effect between different medication therapy in intermediate and poor metabolizers. METHODS: A total of 200 patients with clinical CYP2C19 genotyping test of clopidogrel in our hospital from November 2016 to December 2017 were enrolled in this study. Clinical pharmacists made individualized medication suggestions for patients according to genotypes. For extensive metabolizer, clopidogrel treatment should be continued; for intermediate and poor metabolizers, the alternative anti-platelet medication therapy was recommended. In order to compare the efficacy between the continuing clopidogrel treatment group and the alternative anti-platelet medication therapy group recommended by clinical pharmacist, follow-up was conducted after 12 months.RESULTS:According to inclusion and exclusion standard, 200 patients were enrolled. Among the patients, there were 74 intermediate metabolizers for 37.00%; and there were 43 poor metabolizers for 21.50%. According to genotypes of clopidogrel in 200 patients, clinical pharmacists made individualized medication suggestions for anti-platelet medication therapy, and the adoption rate was 62.00%. Among them, the opinions of extensive metabolizer were entirely adopted. While the adoption rate of intermediate and poor metabolizers were only 35.04%. After 12 months, 117 intermediate and poor metabolizers were followed up, and a total of 23 patients were lost to follow-up. There was no significant difference in the incidence of adverse cardiovascular events between the alternative anti-platelet medication therapy group recommended by clinical pharmacist (n=32) and the continuing clopidogrel treatment group (n=62) (P>0.05). CONCLUSION:Clinical pharmacists can guide the individualized medication according to CYP2C19 gene polymorphism. For intermediate and poor metabolizer, alternative anti-platelet medication therapy cannot reduce the risk of adverse cardiovascular events.

Key words: clopidogrel, CYP2C19 genotyping test, clinical pharmacist, individualized medication therapy, anti-platelet therapy

中图分类号:

R541

杨瑞，刘慧，陈泽姮，戚听听，张赞玲，屈强. 临床药师基于CYP2C19基因检测指导氯吡格雷个体化用药及其疗效评价[J]. 中国临床药理学与治疗学, 2019, 24(8): 938-943.

YANG Rui, LIU Hui, CHEN Zeheng, QI Tingting，ZHANG Zanling, QU Qiang. Clinical pharmacists use CYP2C19 genotyping test to guide individual medication therapy of Clopidogrel and to evaluate the efficacy of treatment[J]. Chinese Journal of Clinical Pharmacology and Therapeutics, 2019, 24(8): 938-943.

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临床药师基于CYP2C19基因检测指导氯吡格雷个体化用药及其疗效评价

Clinical pharmacists use CYP2C19 genotyping test to guide individual medication therapy of Clopidogrel and to evaluate the efficacy of treatment

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