2021 年第 5 期 第 16 卷

CYP2C19基因多态性与冠心病合并肾功能不全患者经皮冠状动脉介入术后1年预后的相关性

Correlation between CYP2C19 polymorphism and 1 year outcomes after percutaneous coronary intervention in coronary atherosclerotic heart disease patients with renal insufficiency

作者：梁静葛海龙王志坚马晓腾周玉杰史冬梅刘巍张琳琳

英文作者：Liang Jing Ge Hailong Wang Zhijian Ma Xiaoteng Zhou Yujie Shi Dongmei Liu Wei Zhang Linlin

单位：首都医科大学附属北京安贞医院心内科北京市心肺血管疾病研究所冠心病精准治疗北京市重点实验室首都医科大学冠心病临床诊疗与研究中心100029

英文单位：Department of Cardiology Beijing Anzhen Hospital Capital Medical University Beijing Institute of Heart Lung and Blood Vessel Diseases Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease Clinical Center for Coronary Heart Disease Capital Medical University Beijing 100029 China

关键词：冠心病（冠状动脉粥样硬化性心脏病）；肾功能不全；CYP2C19基因多态性；经皮冠状动脉介入

英文关键词：Coronaryatheroscleroticheartdisease；Renalinsufficiency；CYP2C19polymorphism；Percutaneouscoronaryintervention

• 摘要：

• 目的 探讨CYP2C19基因多态性与冠心病（冠状动脉粥样硬化性心脏病）合并肾功能不全患者经皮冠状动脉介入（PCI）术后1年预后的相关性。方法  连续入选2016年1月至2017年12月于首都医科大学附属北京安贞医院行PCI治疗的冠心病合并肾功能不全患者182例。根据是否携带CYP2C19功能缺失等位基因分为携带组和未携带组，比较2组患者的临床资料、PCI术后1年主要不良心血管事件（MACE）的发生情况和PCI术后1年累积无MACE生存率，分析PCI术后1年发生MACE的影响因素和2组PCI术后1年发生MACE的风险。结果 182例患者中携带CYP2C19功能缺失等位基因102例（携带组），未携带80例（未携带组）。2组一般资料、吸烟史、既往史、主要临床诊断、冠状动脉病变血管和支架置入情况、左心室射血分数、实验室指标和合并用药情况比较差异均无统计学意义（均P＞0.05）。携带组心源性死亡、心肌梗死、靶病变血运重建、总的支架内血栓发生率和MACE发生率均略高于未携带组［2.9%（3/102）比1.2%（1/80），2.9%（3/102）比1.2%（1/80），12.7%（13/102）比10.0%（8/80），5.9%（6/102）比2.5%（2/80），16.7%（17/102）比10.0%（8/80）］，但组间比较差异均无统计学意义（均P＞0.05）。2组PCI术后1年累积无MACE生存率比较差异无统计学意义（P=0.197）。校正各危险因素后，携带CYP2C19功能缺失等位基因不是冠心病合并肾功能不全患者PCI术后1年发生MACE的危险因素（比值比=1.885,95%置信区间：0.402~6.836，P=0.421），携带组PCI术后1年发生MACE的风险与未携带组比较差异无统计学意义（风险比=2.984,95%置信区间：0.671~7.953，P=0.151）。结论 携带CYP2C19功能缺失等位基因不是冠心病合并肾功能不全患者PCI术后发生MACE的危险因素。

• Objective To investigate the correlation between CYP2C19 polymorphism and 1 year outcomes after percutaneous coronary intervention(PCI) in coronary atherosclerotic heart disease (CHD) patients with renal insufficiency. Methods From January 2016 to December 2017, 182 patients with CHD and renal insufficiency undergoing PCI in Beijing Anzhen Hospital, Capital Medical University were consecutively included. All subjects were divided into carrier group and non-carrier group based on whether carrying the CYP2C19 loss of function(LOF) allele. Clinical data, incidence of major adverse cardiovascular events(MACE)and the cumulative MACE-free survival rate at 1 year after PCI were compared between the two groups. Influencing factors of MACE and risk of MACE at 1 year after PCI in two groups were analyzed. Results Of the 182 patients, 102 cases carried CYP2C19 LOF allele (carrier group) and 80 cases did not (non-carrier group). There were no significant differences in general data, smoking history, past history, main clinical diagnosis, coronary disease vessel and stent implantation, left ventricular ejection fraction, laboratory indicators and concomitant medications between the two groups(all P>0.05). Incidences of cardiac death, myocardial infarction, target lesion revascularization (TLR), total stent thrombosis and MACE in carrier group were slightly higher than those in non-carrier group［2.9%（3/102） vs 1.2%（1/80），2.9%（3/102） vs 1.2%（1/80），12.7%（13/102） vs 10.0%（8/80）， 5.9%（6/102） vs 2.5%（2/80），16.7%（17/102） vs 10.0%（8/80）］, however, the differences between the two groups were not statistically significant(all P>0.05). One year cumulative MACE-free survival rate after PCI was not statistically significant between the two groups(P=0.197). After adjusting for various risk factors, carrying CYP2C19 LOF allele was not the risk factor of MACE at 1 year after PCI in patients with CHD and renal insufficiency(odds ratio=1.885, 95% confidence interval:0.402-6.836, P=0.421). No significant difference in the incidence of MACE at 1 year after PCI between the two groups (hazard ratio=2.984, 95% confidence interval:0.671-7.953, P=0.151). Conclusion Carrying CYP2C19 LOF allele was not the risk factor of MACE in CHD patients complicated with renal insufficiency after PCI.