唐静宜　刘剑敏　张耕

[摘要] 1例63岁女性患者，2013年因冠状动脉粥样硬化性心脏病行经皮冠状动脉介入术（PCI），术后规律服用氯吡格雷和阿司匹林双重抗血小板药物，发生急性心肌梗死。临床药师建议检测其服用的抗血小板药物氯吡格雷和阿司匹林相关基因，根据基因分型结果，建议将氯吡格换成替格瑞洛，阿司匹林用法用量不变。调整给药方案持续治疗6 d后，患者病情好转给予出院。后期随访4个月内患者各项指标在正常范围内，生活质量明显改善。病例提示医药工作者对于PCI术后患者抗血小板药物的选择需要考虑基因型差异，为临床药师如何利用基因检测技术为患者制订个体化给药方案提供参考。

[关键词] 经皮冠状动脉介入术；氯吡格雷；阿司匹林；基因分型

[中图分类号] R969.3 [文献标识码] A [文章编号] 1673-7210（2016）10（b）-0175-03

[Abstract] One 63-year-old female patient accepted percutaneous coronary intervention （PCI） due to coronary atherosclerotic heart disease in 2013. After regular use of Aspirin and Clopidogrel as dual antiplatelet drugs， the acute myocardial infarction still occurred. Clinical pharmacists recommended to test antiplatelet drugs-related genes of Clopidogrel and Aspirin. According to the results of genotyping， clinical pharmacists recommended to replace Clopidogrel to Ticagrelor but Aspirin dosage unchanged. After adjusting the dosing regimen， 6 days of continuous treatment， the patients condition improved to give discharge. During late follow-up within four months， the indicators of the patient were within the normal range and her quality life has improved significantly. This case prompts medical workers that genotypic differences need to be considered when selecting antiplatelet drugs for PCI patients and reminds clinical pharmacists how to use genetic testing to develop individualized dosing regimen for patients.

[Key words] Percutaneous coronary intervention； Clopidogrel； Aspirin； Genotyping

冠状动脉粥样硬化性心脏病（简称“冠心病”）是当今世界威胁人类健康最重要的心血管疾病之一，其主要病理生理机制是冠状动脉粥样硬化狭窄或阻塞所致的心肌缺血坏死[1]。目前经皮冠状动脉介入治疗（percutaneous coronary intervention，PCI）通过心导管技术疏通狭窄甚至闭塞的冠状动脉管腔，重建血管，改善心肌血流灌注，成为治疗冠心病的重要手段。患者PCI术后常规推荐阿司匹林合用氯吡格雷双联抗血小板，但临床资料显示PCI术后患者对这两种药物的反应存在一定个体差异，5%～30%的患者因药物代谢酶和作用靶点基因多态性产生阿司匹林抵抗和/或氯吡格雷抵抗而发生不良心血管事件[2-3]。……