目的 对复方利血平氨苯蝶啶片进行药品临床综合评价,为合理用药及卫生决策提供参考.方法 采用系统性文献综述、真实世界研究等方法,以定性与定量相结合的方式,从安全性、有效性、经济性、创新性、适宜性和可及性6个维度对复方利血平氨苯蝶啶片进行临床综合评价.结果 安全性方面,复方利血平氨苯蝶啶片不良反应发生率与其他常规降压药(对照药物)相比无显著差异;有效性方面,在降低收缩压、舒张压及血压达标率方面与对照药物无显著差异,在总有效率方面优于对照药物;经济性方面,日均用药价格与其他降压药相比处于中间位置,具有一定的经济性.创新性方面,复方利血平氨苯蝶啶片采用4种药物成分小剂量组合联合协同降压,具有理念创新和机制创新.适宜性方面,复方利血平氨苯蝶啶片服用方便,不良反应发生率低,患者依从性良好,符合指南推荐,兼具技术适宜性与使用适宜性.可及性方面,复方利血平氨苯蝶啶片在基层医疗机构覆盖率高、使用广泛,月治疗费用仅为北京市最低月薪标准的1.68%,具有良好的可及性.结论 复方利血平氨苯蝶啶片作为小剂量复方制剂,具有安全、有效、经济、使用方便、覆盖范围广等特点,具有较好的临床价值.

Objective: It remains controversial whether to extend the course of dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI). We conducted a study to investigate the benefits and risks of applying DAPT for different durations after PCI in acute coronary syndromes (ACS) patients in China. What’s more, we explored the efficacy of extended DAPT regimen based on ticagrelor. Methods: This single-center prospective cohort study used data obtained from the PHARM-ACS Patient Registration Database. We included all patients who were discharged between April and December 2018. All patients had at least 18 months of follow-up. Patients were divided into two groups according to the duration of DAPT: a 1-year group and a >1-year group. Potential bias between the two groups was adjusted for by propensity score matching using logistic regression. The primary outcomes were major adverse cardiovascular and cerebrovascular events (MACCE), defined as a composite of death, myocardial infarction, and stroke occurring from 12 months after discharge to follow-up visit. The safety endpoint was any significant bleeding event (BARC ≥ 2). Results: Of 3,205 patients enrolled, 2,201 (68.67%) had DAPT prolonged beyond one year. A total of 2,000 patients were successfully propensity score-matched; patients who received DAPT > 1-year (n = 1000), compared with DAPT = 1-year patients (n = 1000), had a similar risk of MACCE (adjusted HR 0.23, 95% CI 0.05–1.10) and significant bleeding events (adjusted HR 0.63, 95% CI 0.32–1.24). The DAPT > 1-year group had a higher risk of revascularization (adjusted HR 3.36, 95% CI 1.64–6.87). Conclusion: Prolonged DAPT may not be of sufficient benefit to ACS patients within 12–18 months after the index PCI to offset the increased risk of significant bleeding events.

目的 通过对比原研与仿制替格瑞洛在经皮冠状动脉介入(PCI)术后应用的有效性、安全性与经济性,为临床决策与政策实施提供参考.方法 回顾性收集首都医科大学附属北京安贞医院2019年1月至2021年12月诊断为急性冠状动脉综合征(ACS)并接受了PCI手术治疗的患者的相关就诊与随访数据,根据患者使用的替格瑞洛品种分为原研药组与仿制药组.比较2组有效性(血小板最大聚集率及其达标率)、安全性(出血事件)和经济性(用药频度、日均费用)相关指标.结果 共纳入2685例患者,原研药组1838例,仿制药组847例.倾向性评分匹配后2组各841例.2组血小板最大聚集率、血小板最大聚集率达标率比较差异均无统计学意义(均P>0.05).原研药组共9例患者出现便潜血事件,发生率为1.1％(9/841),仿制药组共10例患者出现便潜血事件,发生率为1.2％(10/841).带量采购政策实施后替格瑞洛仿制药用药频度明显高于原研药且日均费用有较大下降.结论 仿制替格瑞洛与原研替格瑞洛的有效性与安全性无显著差异,但具有更好的经济性.

目的 探讨长期使用奥马珠单抗治疗中重度过敏性哮喘的疗效及安全性.方法 通过回顾性、单臂、队列研究,分析中重度过敏性哮喘患者使用奥马珠单抗治疗的疗效和安全性.评估奥马珠单抗治疗6个月及12个月时患者的哮喘控制评分(ACT)、血清IgE水平、呼出气一氧化氮(FeNO)水平、外周血嗜酸性粒细胞计数(EOS)及百分比、肺功能指标、合并用药情况以及不良反应等.结果 共纳入152例患者,分别有152例和113例患者在治疗6个月及12个月时进行了随诊.与奥马珠单抗治疗前相比,治疗6个月和12个月时的ACT评分均有明显升高,治疗12个月时的ACT评分相比于治疗6个月时有显著升高(P<0.01);治疗6个月时的FeNO、EOS百分比及EOS计数均较治疗前降低(P<0.01),治疗12个月时未见显著变化;治疗6个月和12个月时的第1秒用力呼气容积占预计值的百分比均高于治疗前(P<0.01);持续治疗12个月时,哮喘患者合并用药剂量及使用率显著下降(P<0.01).奥马珠单抗治疗过程中51例(33.6%)患者发生了不良反应,药物不良反应较轻微.结论 对中重度过敏性哮喘患者持续应用奥马珠单抗治疗至12个月,能够持续改善哮喘情况,减少合并用药的剂量和使用频率.

目的 通过新型冠状病毒肺炎疫情时期基于"互联网+"药学模式的实践与思考,为今后应对突发公共卫生事件中长期固定用药患者的药品供应及药学服务奠定基础.方法 通过检索中国知网、万方数据、PubMed等数据库,自制调查问卷,采用简单随机抽样的方式,对首都医科大学附属北京安贞医院门诊就诊患者及使用过线上复诊和药品递送服务系统的患者进行调研.2021年2-3月采用现场发放问卷及电话随访方式进行第一轮调查,获取有效问卷141份.根据第一轮调查反馈结果对服务系统进行优化,并于2021年6-7月使用电话随访方式进行第二轮调研,获取有效问卷104份.对患者的人群特征、基本状况、对线上服务的了解程度、接受程度、满意程度及改进建议等结果进行统计分析.结果 第一轮调查结果显示,141份调查问卷中,知道且使用过线上复诊及药品递送服务的患者占35.5％(50/141),79.4％(112/141)患者认为该服务对自己有帮助,74.5％(105/141)患者表示愿意使用该服务.患者对该服务的顾虑主要为物流延迟、药物退换和药物配送问题等.第二轮调查结果显示,92.3％(96/104)患者认为线上复诊和药品递送服务系统使用方便,90.4％(94/104)患者对服务质量感到满意,93.3％(97/104)患者认为该服务对自己有帮助,90.4％(94/104)患者愿意继续使用该服务,但仍存在线上复诊及购药不能报销、候诊时间较长和快递费用略高等问题.结论 新型冠状病毒肺炎疫情常态化促进了"互联网+"药学模式的建立,一定程度上解决了基层药品储备相对不足的问题."互联网+"药学模式通过提供个体化、精准的用药监测和教育能更好地发挥临床药师的价值,保证患者的用药合理性.

目的 系统评价氯沙坦对比其他血管紧张素受体拮抗剂(ARB)对高血压患者血尿酸水平的影响,为临床有降尿酸需求的高血压患者用药决策提供循证证据.方法 检索PubMed、Embase、Cochrane Library、中国知网(CNKI)、万方、维普等数据库,纳入符合标准的随机对照研究(RCT)及队列研究.评价纳入研究质量并根据设计的Excel表格提取数据,以加权均数差(WMD)为效应量,使用RevMan5.4版、Stata 15版软件进行Meta分析,GRADEpro GDT网站进行证据质量评价.结果 共纳入24篇文献,其中13项RCT,11项队列研究.结果 显示,氯沙坦对比其他ARB能有效降低血尿酸水平,优于替米沙坦(WMD=-81.54,95％CI:-108.71～-54.38),缬沙坦(WMD=-92.19,95％CI:-125.49～-58.89),坎地沙坦酯(WMD=-27.34,95％CI:-35.92～-18.76)及厄贝沙坦(WMD=-91.82,95％CI:-148.00～-35.64);与奥美沙坦和依普沙坦(WMD=-12.62,95％CI:-32.54～7.30)相比差异无统计学意义.结论 当前证据显示,在ARB类降压药中,氯沙坦具有显著降低血尿酸水平的优势,且这一优势与目标人群是否合并高尿酸血症、氯沙坦剂量和用药时长无明显相关.

The association between metformin use and neurodegenerative disease (ND) onset remains controversial. In this systematic review and meta‐analysis, we aimed to determine the relationship between metformin use and ND risk based on data from population‐based cohort studies.

Abstract Background: To evaluate the accuracy and predictive performance of multiple linear regression algorithms, Gage algorithm and International Warfarin Pharmacogenetics Consortium (IWPC) algorithm, and Bayesian algorithm for the maintenance dose of warfarin in Asian patients after aortic surgery. Methods:The predictive performance of Gage, IWPC and Bayesian algorithm were compared by calculating mean prediction error (MPE), mean squared error (MSE), root-mean-squared error (RMSE), and the percentage of patients whose predicted warfarin dose fell within 20% of the maintenance dose. Then the predictive performance of each algorithm was calculated separately in conventional dose group (dose of warfarin between 3mg and 3.75mg) and unconventional dose group (dose less than 3mg or more than 3.75mg). Results: Among three algorithms, the Gage algorithm predicted the warfarin dose with the highest percentage within 20% (58.1%). Bayesian-priori (dose estimation before starting therapy) algorithm had the highest RMSE (1.45 mg/day) and the lowest percentage within 20% (40.9%). The algorithm of Gage method tended to perform better in the conventional dose group (percentage within 20%: 70.0%), and Bayesian-priori method performed better in the unconventional dose group (percentage within 20%: 38.5%). And as the number of international normalized ratio (INR) observations increases, the predictive performance of Bayesian-posteriori (dose estimation after initiating therapy) algorithm showed an increasing trend in both groups and a significantly higher advantage, especially in the unconventional dose group. Conclusion: For Asian patients after aortic surgery, the Gage algorithm was appropriate for patients requiring conventional dose (2.25-3.75mg). Bayesian-posteriori algorithm might be more appropriate for patients requiring high dose or low dose (＜2.25mg or＞3.75mg).

Objective This article compares the clinical outcomes of clopidogrel and ticagrelor in patients with acute coronary syndrome (ACS) without cytochrome P450 (CYP)2C19 loss-of-function (LOF) alleles and investigates whether clopidogrel could be an alternative P2Y12 inhibitor without increasing the risk of ischemic events. Methods Patients were divided into the clopidogrel-treated group and the ticagrelor-treated group. Inverse probability of treatment weighting (IPTW) calculated by propensity scores was used to adjust confounding covariates. The primary outcome was major adverse cardiovascular or cerebrovascular events (MACCEs) within 12 months. The secondary outcomes were MACCEs plus unstable angina, and clinically significant bleeding events. Results Finally, 2,199 patients were included. Of them, 1,606 were treated with clopidogrel, and 593 were treated with ticagrelor. The mean age of the original cohort was 59.929.81 years. During the 12-month follow-up period, MACCEs occurred in 89 patients (4.0%). No significant differences were observed in MACCEs (IPTW-adjusted hazard ratio [HR], 0.87; 95% confidence interval [CI], 0.65-1.18), MACCEs plus unstable angina (IPTW-adjusted HR, 1.20; 95% CI, 0.91-1.59), or clinically significant bleeding events (IPTW-adjusted HR, 0.81; 95% CI, 0.53-1.23) between the clopidogrel- and ticagrelor-treated groups. Conclusion In patients with ACS without CYP2C19 LOF alleles, clopidogrel was not associated with a higher risk of MACCEs when compared with ticagrelor. The main findings of this study support use of clopidogrel in CYP2C19 LOF noncarriers as an alternative P2Y12 inhibitor, which may reduce medical expenses and adverse reactions caused by more potent P2Y12 inhibitors in these patients.

Background and ObjectivesIt is unclear whether more potent P2Y12 inhibitors are of benefit to older patients who are at high risk for both ischemia and bleeding. We conducted an observational study to compare the clinical outcomes of clopidogrel and ticagrelor uses in older patients with an acute coronary syndrome (ACS).MethodsOlder patients (aged ≥65 years) with ACS who underwent percutaneous coronary intervention (PCI) were divided into clopidogrel-treated and ticagrelor-treated groups. The primary observational endpoint was the occurrence of net adverse clinical and cerebral events (NACCEs) during a 12-month period, which is defined as the composite endpoint of all-cause death, myocardial infarction (MI), stroke, stent thrombosis, urgent coronary revascularization, and clinically significant bleeding. The secondary endpoints were clinically significant bleeding and major adverse clinical and cerebral events (MACCEs).ResultsThis study included a total of 2,611 patients. Of them, 1,636 received clopidogrel and 975 received ticagrelor. Between patients receiving clopidogrel and those receiving ticagrelor, no significant differences were noted in NACCE (8.4 vs. 9.7%, respectively; adjusted hazard ratio [HR], 0.86; 95% confidence interval [CI], 0.66–1.12) or MACCE (7.1 vs. 7.0%, respectively; adjusted HR, 1.13; 95% CI, 0.83–1.55) during the 12-month follow-up period. In contrast, the occurrence of clinically significant bleeding was significantly less in clopidogrel-treated patients compared with that in ticagrelor-treated patients (27, 1.7%, vs. 31, 3.2%, respectively; adjusted HR, 0.42; 95% CI, 0.25–0.69). Stratified analyses revealed no significant association between age (≥75 years vs. <75 years) and treatment condition in terms of primary or secondary endpoints.ConclusionThis study showed that clopidogrel and ticagrelor had comparable net clinical benefits in patients with ACS aged ≥65 years. Additionally, clopidogrel was associated with a significantly lower risk of major bleeding than ticagrelor without an increase in ischemic risk. These findings suggest that clopidogrel is an effective alternative to the more potent P2Y12 inhibitor ticagrelor in older patients.

目的 通过构建电子平台探索药师开展线上药物治疗管理服务的可行性,并调查患者使用平台后疾病的控制情况.方法 基于药物治疗管理的核心要素设计平台.通过匿名在线进行调查问卷,从2020年7—12月期间使用平台的患者中随机抽取25％展开调查.采用自行设计的调查问卷,内容包含使用平台前患者药物了解程度、使用平台后患者疾病控制情况以及就医方便程度和满意度4个方面.结果 本研究构建了一个可实现线上服务的药物治疗管理平台.在随机抽取患者中120例(87.0％)回应并得到有效问卷.其中,中老年患者占75.7％,至少患有1种慢性疾病的占97.6％.患者使用平台后,用药认识提高的占90.0％,解决了药物治疗相关问题的占34.2％,疾病有改善的占60.8％.外省市患者占71.7％,对平台满意的占92.4％.结论 平台的使用有利于中老年慢性病的控制,可提高用药认识,解决用药问题.

目的 对2015-2019年国家自然基金资助的动脉硬化相关项目进行分析,探讨当前该领域的研究热点,为后续开展动脉粥样硬化相关研究提供参考.方法 统计2015-2019年立项的动脉粥样硬化相关项目,对立项年度、类型、学科分布等情况进行分析,并应用CiteSpace软件进行关键词可视化分析,探究当前国家自然科学基金对于动脉粥样硬化领域的资助热点.结果 近5年动脉粥样硬化相关项目的 立项总数为662项,每年立项数目整体较为稳定.其中所属医学科学部有612项(92.4％)占比最高,立项呈现多学科协同现象.资助项目地区分布不均衡,立项集中于北京、上海、广东等地区.关键词共现结果显示,巨噬细胞、炎症、内皮细胞为出现频率前3名的关键词.关键词聚类结果显示内皮细胞、巨噬细胞、微RNA为前3名的研究类团.结论 国家自然科学基金是国家对于基础研究的重要支撑,研究者应把握研究热点,多学科协同,多技术联用,推动动脉粥样硬化研究的更深层次探索.

目的 评估基于"三医联动"(医疗、医药、医疗保险)的合理用药管理模式在P2Y12受体抑制剂管理中的效果.方法 构建基于"三医联动"的合理用药管理模式,调取首都医科大学附属北京安贞医院2018年4—9月(合理用药管理模式实施前)及2019年4—9月(合理用药管理模式实施后)药品费用数据及使用P2Y12受体抑制剂的住院患者病历进行统计分析.结果 在纳入的3356例患者中,合理用药管理模式实施后血小板抑制率较实施前有所上升[(53.2±0.7)％比(51.4±0.6)％](t=-1.896,P=0.058);实施后与实施前血小板抑制达标率差异无统计学意义[80.8％(988/1223)比78.7％(1678/2133)](χ2=2.132,P=0.144).实施后与实施前尿潜血、便潜血、出血事件及中重度出血发生率差异均无统计学意义(均P>0.05).模式实施后P2Y12受体抑制剂总体药品费用较实施前同期下降700.0万元,降幅27.9％(700.0/2507.3),用药结构指数为0.95.结论 基于"三医联动"的合理用药管理模式降低了药品费用,保障了患者用药安全,对促进临床合理用药有重要意义.

Introduction: Voltage-gated sodium (Nav) channels encoded by SCNs are heteromeric protein complexes containing pore-forming α subunits together with non-pore-forming β subunits. Methods: To analyze the expression of SCNs in the samples of different types of breast cancer (BC) patients and the relationship between the expression of α and β subunits and the prognosis of in BC patients, the study investigated the roles of SCNs in the prognosis of BC using ONCOMINE, UALCAN, Kaplan-Meier Plotter, GEPIA, Metascape, LinkedOmics databases. The study analyzed significant changes of SCNs expression and prognosis in transcription level between BC and normal samples, and association of mRNA expression of distinct SCNs family members with prognosis in overall BC patients and HER2-positive/HER2-negative subgroups, respectively. Moreover, we predicted functions and pathways of the mutations in SCNs and their neighbor genes in BC patients by GO/KEGG and GSEA analysis. Results: The results showed that transcriptional and proteinic expressions of 9 SCNs were downregulated in patients with BC, including SCN1A~4A, 7A, 9A and SCN2B~4B. low expressions of 11 SCNs members were found to be significantly associated with poorer overall survival (OS) in BC patients (P＜0.01), including SCN2A, 3A, 5A, 7A, 9A~11A and SCN1B~4B. Moreover, prognostic value of mRNA expression of SCNs could only be seen in HER2-negative BC patients when we performed subgroup analysis. Conclusions: These results indicated that SCNs could be prognostic biomarkers for survivals of BC patients. Some medicines that regulate SCNs might provide new targets for BC treatment.

Background: The clinical benefits of cytochrome P450 (CYP) 2C19 genotype-guided antiplatelet therapy in Asians remain unclear. In this study, we aimed to investigate the clinical outcomes of pharmacogenomic antiplatelet therapy in Chinese patients.Methods: Patients with acute coronary syndrome planning to undergo percutaneous coronary intervention were eligible for this study and were randomly divided into a genotype-guided treatment (GT) group and routine treatment (RT) group, with a ratio of 2:1. Patients in the GT group underwent CYP2C19 genotyping (*2 and *3 alleles), and the results were considered in selecting P2Y12 receptor inhibitors. Patients in the RT group were treated with P2Y12 receptor inhibitors according to their clinical characteristics. The primary endpoint was a composite of major adverse cardiovascular or cerebrovascular events (MACCE). The secondary endpoint was significant bleeding events.Results: Finally, 301 patients were enrolled; 75.1% were men and the mean age was 59.7 ± 9.8 years. In total, 281 patients completed the follow-up procedure. The primary endpoint occurred in 16 patients, 6 patients in the GT group and 10 in the RT group. The GT group showed lower MACCE rates than the RT group (6/189 vs. 10/92, 3.2 vs. 10.9%, hazard ratio: 0.281, 95% confidence interval: 0.102–0.773, P = 0.009). There was no statistically difference in significant bleeding events between the GT and RT groups (4.2 vs. 3.3%, hazard ratio: 1.315, 95% confidence interval: 0.349–4.956, P = 0.685).Conclusion: Personalized antiplatelet therapy that is based on CYP2C19 genotypes could decrease MACCE within a 12-month period in Chinese patients with acute coronary syndrome undergoing percutaneous coronary intervention.Clinical Trial Registration:http://www.chictr.org.cn, identifier: ChiCTR2000034352.

目的:评估国产与进口氯吡格雷口服常释剂型的有效性和安全性及药物经济学差异,为“4+7”带量采购政策执行对患者治疗模式和医疗费用支出的影响提供数据支持.方法:提取首都医科大学附属北京安贞医院急性冠脉综合征患者药物治疗相关因素与临床结局的病例,研究患者登记数据库中使用氯吡格雷患者的基线及随访信息及医院药品费用数据,根据所用药物品种分为中标药组及原研药组进行统计分析.结果:原研药组MACCE的发生率与中标药组(4.91％ vs.5.07％,P=0.83)无显著性差异,全因死亡、心血管相关死亡、心肌梗死、卒中、血运重建及支架内血栓等各单独终点事件及主要出血事件发生率与中标药组无显著性差异(log-rank P=0.60).2019年4-9月氯吡格雷用量较政策实施前2018年同期使用金额下降874.4万元.结论:中标品种氯吡格雷与进口同类药物相比,在急性冠脉综合征患者经皮冠状动脉介入治疗后的疗效可靠,安全性好,具有较大价格优势.

Atherosclerosis (AS) is one of the most severe cardio-vascular diseases involved in the phenotypic switching of vascular smooth muscle cells (VSMCs). Tryptanthrin is a natural product with broad biological activities. However, the effect of tryptanthrin on atherosclerotic progression is unclear. The aim of this study was to determine the role of tryptanthrin in AS and explore the potential mechanism. In vitro, primary VSMCs were stimulated with platelet-derived growth factor-BB (PDGF) to induce cell dedifferentiation. Treatment with tryptanthrin (5 mu M or 10 mu M) suppressed the proliferation and recovered the contractility of VSMCs in the presence of PDGF. The contractile proteins (alpha-smooth muscle actin, calponin, and SM22 alpha) were increased, and the synthetic protein vimentin was decreased by tryptanthrin in PDGF-induced VSMCs. ApoE(-/-) mice fed with high-fat diet were used as an in vivo model of AS. Similarly, gavage administration of tryptanthrin (50 mg/kg or 100 mg/kg) attenuated VSMC phenotypic changes from a contractile to a synthetic state in aortic tissues of AS mice. The serum lipid level, atherosclerotic plaque formation, and arterial intimal hyperplasia were attenuated by tryptanthrin Furthermore, tryptanthrin increased the expression levels of phosphorylated AMP-activated protein kinase (AMPK) and acetyl-CoA carboxylase (ACC) both in vitro and in vivo. Administration of compound C, an AMPK inhibitor, reversed the inhibitory effect of tryptanthrin on VSMC dedifferentiation in vitro. Thus, we demonstrate that tryptanthrin protects against AS progression through the inhibition of VSMC switching from a contractile to a pathological synthetic phenotype by the activation of AMPK/ACC pathway. It provides novel insights into AS prevention and treatment.

Background: CYP2C19 loss-of-function (LOF) alleles reduce the effectiveness of clopidogrel in patients undergoing percutaneous coronary intervention for acute coronary syndrome. However, the clinical impact of implementing CYP2C19 gene-guided pharmacotherapy is unclear, especially among the Chinese population. The purpose of this study was to evaluate P2Y12 receptor inhibitor selection and clinical outcomes upon implementation of CYP2C19 genotype-guided pharmacotherapy in current clinical practice.Methods: This was a single-center observational cohort study. Adult percutaneous coronary intervention patients who received CYP2C19 genetic testing (*2, *3, *17 alleles) were included. Ticagrelor was recommended for patients with a LOF allele. Factors related to P2Y12 inhibitor selection were determined by logistic regression. The primary endpoint was major cardiac or cerebrovascular adverse events (MACCE) within 12 months. MACCE and clinically significant bleeding events (BARC ≥2) in the LOF-clopidogrel group, non-LOF-clopidogrel group, and non-LOF-ticagrelor group were compared with those in the LOF-ticagrelor group. The inverse probability of treatment weighting (IPTW) was adjusted in a Cox regression analysis to eliminate confounding factors.Results: Among 1,361 patients, 826 (60.7%) had a LOF allele. Patients with a LOF allele were more likely to be prescribed ticagrelor (multivariate-adjusted OR 1.349; 95% CI 1.040 to 1.751; p = 0.024). The MACCE rate was higher in the LOF-clopidogrel group than in the LOF-ticagrelor group (7.8 vs. 4.0%; log-rank p = 0.029; IPTW-adjusted HR 2.138; 95% CI 1.300–3.515). Compared with the LOF-ticagrelor group, the non-LOF-clopidogrel group showed no significant difference in MACCE rate (5.8 vs. 4.0%; log-rank p = 0.272; IPTW-adjusted HR 1.531; 95% CI 0.864–2.714). Among the patients treated with ticagrelor, there was no significant difference in the MACCE rate between the LOF group and non-LOF group (4.3 vs. 4.0%; log-rank p = 0.846; IPTW-adjusted HR 1.184; 95% CI 0.582–2.410). There was no significant difference in the incidence of clinically significant bleeding events among the four groups.Conclusion: This study confirms that efficiently returned CYP2C19 genotype results did partially guide cardiologists to prescribe ticagrelor for patients with a LOF allele, and that clopidogrel had a higher risk of MACCE than ticagrelor in these patients, which provides support for the implementation of CYP2C19 gene-guided antiplatelet therapy in clinical practice.

血小板功能检测在抗血小板个体化治疗中起到的作用仍存在争议,本文围绕血小板功能检测方法、临床指南及共识、临床研究等方面,综述血小板功能检测指导P2Y12受体拮抗剂个体化治疗的研究进展.