LVBIGELEIGETIHUAYONGYAOJIANCE
氯吡格雷(Clopidogrel),SHANGPINMINGWEIBOLIWEI、TAIJIA,SHIMUQIANLINCHUANGSHANGCHANGYONGDESAIFENBINGBIDINGLEIKANGXUEXIAOBANYAOWU,ZHUYAOYONGYUGUANXINBING(CAD)、JIXINGGUANZHUANGDONGMAIZONGHEZHENG(ACS)、GUANZHUANGDONGMAIZHIJIA(PCI)SHUHOUKANGXUEXIAOBANJUJIZHILIAO。
氯吡格雷是一种前体药物,需要经肝脏CYP2C19酶代谢为有效活性产物才能发挥抗血小板聚集作用。研究表明,CYP2C19酶在氯吡格雷代谢转化中发挥重要作用,其基因多态性是影响氯吡格雷疗效及安全性的重要原因。CYP2C19 根据其基因型不同可将人群分为超快代谢型、快代谢型、中等代谢型和慢代谢型。CYP2C19 *1是功能正常的等位基因,对氯吡格雷的代谢功能完好;CYP2C19 *2和CYP2C19 *3是最为常见的功能丧失的等位基因,约占亚洲人群弱代谢表型的99%以上,携带这两种基因型的患者对氯吡格雷代谢能力减弱;CYP2C19 *17SHIGONGNENGZENGQIANGXINGDENGWEIJIYIN,XIEDAIGAIJIYINXINGDEHUANZHEDUILVBIGELEIDAIXIENENGLIZENGQIANG。
目前,美国FDA对氯吡格雷用药提出了黑框警告,建议服用氯吡格雷的CYP2C19 慢代谢患者考虑换药,并指出对CYP2C19 JIYINXINGJINXINGJIANCEKENENGYOUZHUYUYOUHUAZHILIAO。
DUIYUZHENGZAIHUOKAOLVJIESHOULVBIGELEIKANGXUEXIAOBANJUJIZHILIAODEHUANZHE,TONGGUOJIYINTUBIANJIANCE,KETIQIANZHIXIAOHUANZHEDEDAIXIESULVLEIXINGHEMINGANCHENGDU,GENJUGERENYICHUANTEZHENG,ZHIDINGGETIHUAZHILIAOFANGAN,XUANZEHELIDEYAOWUJIYONGYAOJILIANG,JIANSHAOWUXIAOYONGYAOHEYAOWUBULIANGFANYINGDEFASHENG。
l LVBIGELEIYONGYAOGUOCHENGZHONGCHUXIANNAIYAODEHUANZHE;
l XUYAOTONGGUODUOJIYIN、DUOWEIDIANJIANCE,YIZHIDINGWANSHANDELVBIGELEIYONGYAOFANGANDEHUANZHE。
l FUYONGLVBIGELEIKANGXUEXIAOBANZHILIAODEZHONGGAOWEIHUANZHE,RUZHIRUGUANZHUANGDONGMAIZHIJIA(PCI)、JIXINGGUANZHUANGDONGMAIZONGHEZHENG、XINZANGBANMOJIBING、TANGNIAOBINGHUANZHE。
针对氯吡格雷个体化用药基因检测,检测CYP2C19 JIYINDE3GESNPWEIDIAN【*2 c.681G>A, *3 c.636 G>A,*17 c.-806C>T】。
1. Scott SA, SangkuhI K, et al. Clinical pharmacogenetics implementation consortium guidelines for cytochrome P450-2C19 (CYP2C19) genotype and clopidogrel therapy. Clin Pharmacol Ther. 2011, 90(2): 328-332.
2. Mega JL, Hochholzer W, et al. Dosing clopidogrel based on CYP2C19 genotype and the effect on platelet reactivity in patients with stable cardiovascular disease. JAMA. 2011, 306(20): 2221-2228.
3. 周宏灏, 陈小平等. 药物代谢酶和药物作用靶点基因检测技术指南(试行).
4. PHARMGKB. //www.pharmgkb.org/
最后更新于:2020年03月
基因检测