目的: 研究内蒙古自治区西部蒙古族经皮冠状动脉介入治疗术( percutaneous coronary intervention，
PCI) 病人CYP2C19 基因多态性与氯吡格雷抵抗的相关性，为蒙古族病人临床个体化治疗提供依据。方法: 选取
2013－10～ 2016－09 在内蒙古医科大学附属医院急诊内科接受PCI 治疗的蒙古族冠心病病人83 例进行CYP2C19
基因型检测，并按照基因型进行分组，比较平均血小板聚集率降低情况、氯吡格雷抵抗和随访12mo 不良心血管
事件的再发生情况。结果: ( 1) 入选病人的各基因型分布为快代谢型基因组( * 1 /* 1) 32 例，占总例数38．6%;
中间代谢型基因组( * 1 /* 2、* 1 /* 3) 为35 例，占总例数42．1%; 慢代谢型基因组( * 2 /* 2、* 2 /* 3、* 3 /* 3)
共16 例，占总例数19．2%。( 2) 快代谢型基因型组出现氯吡格雷抵抗率( 15．6%) 明显低于中间代谢型基因组
( 32．4%) 及慢代谢型基因组( 43．8%) ，P＜0．05; 快代谢型基因组平均血小板聚集降低率( 20．76±12．11) %明显高
于中间代谢型基因组( 15．44±9．38) %及慢代谢型基因组的( 13．83±11．43) %，P＜0．05; 快代谢型基因组的心血管
不良事件发生率( 25．0%) 明显少于中间代谢型基因组( 48．6%) 及慢代谢型基因组( 64．2%) ，P＜0．05。结论: 用氯
吡格雷治疗蒙古族PCI 病人过程中CYP2C19 基因多态性对其疗效具有明显影响作用，应根据病人基因型制定
个性化治疗方案。

Objective: To investigate the relationship of CYP2C19gene polymorphisms and clopidogrel
resistance in Chinese Mongolian population patients from western Inner Mongolia who accepted
percutaneous coronary intervention( PCI) ．Methods: To selecte 83 cases of coronary heart
disease( CHD) patients who accepted PCI in emergency medicine of Inner Mongolia medical university
affiliated hospital and detect CYP2C19gene． According to the different genotypes，the
patients were divided into different groups．to compare the average platelet aggregation rate between
different genotype groups，clopidogrel resistance reduction and followed up for 12months of adverse
cardiovascular events happening again． Results: ( 1 ) For the genotype distribution of fast
metabolism in patients with genotype( * 1 /* 1) has 32 cases，accounted for 38．6%，intermediate
metabolism genotype ( * 1 /* 2、* 1 /* 3) has 35 cases，accounted for 42．1%，slow metabolism
genotype ( * 2 /* 2、* 2 /* 3、* 3 /* 3 ) has 16 cases，accounted for ( 19．2%) ; ( 2 ) After
treatment with clopidogrel，the group of fast metabolism genotype which has clopidogrel resistance
rate( 15．6%) was lower than that in group intermediary metabolism genotype ( 32．4%) and slow
metabolism genotype( 43．8%) ，P＜ 0．05; The average reduce platelet aggregation rate of fast metabolism
group( 20．76±12．11) %is significantly higher than the intermediary metabolism genotype
( 15．44±9．38) %and slow metabolism genotype( 13．83±11．43) %，P＜0．05; The incidence of adverse
cardiovascular events( 25．0%) in fast metabolism group was obviously less than the intermediary
metabolism genotype( 48．6%) and slow metabolism genotype( 64．2%) ，P＜ 0．05． The difference
was statistically significant．Conclusion: The CYP2C19gene polymorphisms has obvious effect
on curative effect in the Mongolian PCI patients treated by clopidogrel，we should make individualized
treatment plan according to the genotype of patients．

R392．2

 收稿日期: 2016－11－20; 修回日期: 2017－02－17
基金项目: 国家自然科学基金( 81441125)
作者简介: 李桂梅( 1981－) ，女，内蒙古医科大学附属医院急诊内科主治医师。