目的 分析注射用丹參多酚酸聯(lián)合雙聯(lián)抗血小板藥物對(duì)CYP2C19基因變異的頸動(dòng)脈支架植入術(shù)后患者的治療作用。方法 選取河南大學(xué)第一附屬醫(yī)院2014年1月-2017年8月96例CYP2C19基因突變且植入頸動(dòng)脈支架的患者為研究對(duì)象，抽簽隨機(jī)分為丹參多酚組與對(duì)照組，每組48例。對(duì)照組患者術(shù)后接受雙聯(lián)抗血小板（阿司匹林100 mg qd+氯吡格雷75mg qd）+降脂（阿托伐他汀鈣片20 mg qn）治療，丹參多酚組除上述治療外，術(shù)前iv注射用丹參多酚酸0.13 g，術(shù)后每日1次，每次0.13 g，共應(yīng)用14 d。觀察兩組治療前及治療后超敏C反應(yīng)蛋白（hs-CRP）、白介素-6（IL-6）、腫瘤壞死因子-α（TNF-α）、內(nèi)皮素-1（ET-1）、丙二醛（MDA）、一氧化氮（NO）、超氧化物歧化酶（SOD）、親環(huán)素A（CyPA）、8異前列腺素F2α（8-iso-PGF2α）水平。術(shù)后隨訪1年，記錄主要負(fù)性臨床事件。結(jié)果 治療前兩組上述指標(biāo)無(wú)統(tǒng)計(jì)學(xué)差異；治療后兩組NO、SOD高于治療前，hs-CRP、IL-6、TNF-α、ET-1、MDA、CyPA、8-iso-PGF2α均低于治療前，同組治療前后比較差異有統(tǒng)計(jì)學(xué)意義（P<0.05）；且治療后丹參多酚組NO、SOD高于對(duì)照組，hs-CRP、IL-6、TNF-α、ET-1、MDA、CyPA、8-iso-PGF2α低于對(duì)照組，組間差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。丹參多酚組隨訪期間主要負(fù)性臨床事件顯著低于對(duì)照組，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。結(jié)論 注射用丹參多酚酸聯(lián)合雙聯(lián)抗血小板治療能夠?yàn)镃YP2C19基因變異的頸動(dòng)脈狹窄患者在頸動(dòng)脈支架植入術(shù)后提供更好的內(nèi)皮功能改善，更大程度地緩解炎癥及氧化應(yīng)激狀態(tài)，降低主要負(fù)性臨床事件發(fā)生風(fēng)險(xiǎn)。

Objective To analyze the therapeutic effect of Salvianolic Acids for Injection combined with dual antiplatelet therapy on patients with CYP2C19 gene mutation after percutaneous carotid artery stenting. Methods A total of 96 cases with mutational CYP2C19 genotypes treated with percutaneous carotid artery stenting in our hospital from January 2014 to August 2017 were enrolled into our study,they were randomly divided into the salvianolate group and the control group, with 48 cases in each group. The level of hs-CRP, IL-6, TNF-α, ET-1, MDA, NO, SOD, CyPA, 8-iso-PGF2α were observed before and after treatment in the two groups. The major adverse clinical events were recorded during the 1-year follow-up period. Results There was no statistical difference between the two groups before treatment. After treatment, level of NO and SOD were higher in both groups than pretreatment, while level of hs-CRP, IL-6, TNF-α, ET-1, CyPA, 8-iso-PGF2α and MDA were lower in both groups than pre-treatment (P<0.05). Level of NO and SOD were higher in the salvianolate group than in the control group, while level of hs-CRP, IL-6, TNF-α, ET-1, CyPA, 8-iso-PGF2α and MDA were lower in the salvianolate group than in the control group (P<0.05). The major adverse clinical events were significantly higher in the salvianolate group than in the control group (P=0.028). Conclusion Salvianolic Acids for Injection combined with dual antiplatelet therapy can provide better endothelial function improvement in patients with CYP2C19 gene mutation after percutaneous carotid artery stenting, and relieve inflammation and oxidative stress better as well, reduce the risk of major adverse clinical events.

河南省教育廳科學(xué)技術(shù)研究重點(diǎn)項(xiàng)目（18A310012）