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目的系统评价CYP2C19*17多态性对服用氯吡格雷治疗的心血管疾病患者临床疗效的影响。方法计算机检索EMbase、PubMed、h e Cochrane Library、ClinicalTrials.gov、CBM、CNKI、WanFang Data和VIP数据库,查找有关CYP2C19*17多态性对氯吡格雷疗效影响的研究,检索时限均为建库至2012年10月。由2位研究者按照纳入与排除标准独立筛选文献、提取资料和评价质量后,采用RevMan 5.2软件进行Meta分析。结果最终纳入6篇文献共7个研究,包含12116例患者,其中CYP2C19*17携带者5578例,CYP2C19*17非携带者6538例。Meta分析结果显示:与CYP2C19*17非携带者相比,CYP2C19*17突变携带者服用氯吡格雷心血管事件发生风险降低[OR=0.85,95%CI(0.73,0.99),P=0.03],但出血性事件发生风险增加[OR=1.25,95%CI(1.05,1.50),P=0.01]。结论服用氯吡格雷治疗的CYP2C19*17基因突变心血管疾病患者,其心血管事件发生风险相对较低,但出血性事件发生风险相对较高。
Objective To evaluate the effect of CYP2C19 * 17 polymorphism on the clinical efficacy of patients with cardiovascular diseases treated with clopidogrel. Methods The databases of EMbase, PubMed, HeCochrane Library, ClinicalTrials.gov, CBM, CNKI, WanFang Data and VIP were searched to find out the effect of CYP2C19 * 17 polymorphism on the efficacy of clopidogrel. In October. Two researchers independently screened the literature according to inclusion and exclusion criteria, extracted data, and evaluated the quality. Meta-analysis was performed using RevMan 5.2 software. The results of the final inclusion of 6 articles in a total of 7 studies, including 12,116 patients, of which CYP2C19 * 17 carriers 5578 cases, CYP2C19 * 17 non-carriers of 6538 cases. Meta-analysis showed that compared with CYP2C19 * 17 non-carriers, CYP2C19 * 17 mutation carriers had lower risk of taking clopidogrel in cardiovascular events [OR = 0.85, 95% CI (0.73, 0.99), P = 0.03] However, the risk of hemorrhagic events increased [OR = 1.25, 95% CI (1.05, 1.50), P = 0.01]. Conclusion The risk of cardiovascular events in patients with CYP2C19 * 17 gene mutation clopidogrel treated with clopidogrel is relatively low, but the risk of hemorrhagic events is relatively high.