Département de Cardiologie, CHU Timone, Marseille, France.
Thromb Haemost. 2010 Apr;103(4):774-9. doi: 10.1160/TH09-06-0355. Epub 2010 Feb 2.
Platelet response to clopidogrel shows inter-individual variability that is partially explained by genetic polymorphisms. This variability affects clinical outcome when clopidogrel is administered in patients with acute coronary syndrome (ACS). Catecholamines, released during ACS, contribute to platelet aggregation through platelet alpha2A-(alpha2A-AR) and beta2-adrenergic receptor (beta2-AR) stimulation. It was the objective of this study to assess the potential influence of alpha2A-AR and beta2-AR gene polymorphisms on platelet reactivity after dual antiplatelet therapy with aspirin and clopidogrel in ACS. We screened 641 ACS patients for 6.3/6.7 kb alpha2A-AR polymorphism, and for Arg16Gly and Gln27Glu beta2-AR polymorphism. After 600 mg clopidogrel, we assessed ADP 10 micromol-induced platelet aggregation (ADP-Ag) and vasoactive stimulated phosphoprotein (VASP). All single nucleotide polymorphisms were in Hardy-Weinberg equilibrium. A slight though negligible association was found between 6.3 kb allele of alpha2A-AR with platelet reactivity ADP-Ag induced (beta: -2.91 [-5.68;-0.14], p=0.04). A borderline not significant reduction in PRI VASP was observed in 6.3 kb alpha2A-AR carriers (beta: -3.81 [-0.09;7.72], p=0.06). No significant effect on platelet parameters was observed for the other tested polymorphisms. Common alpha2A- and beta2-adrenergic receptor polymorphisms do not show any major impact on residual platelet reactivity in non-ST-elevation ACS when a dual antiplatelet therapy with 250 mg aspirin and 600 mg clopidogrel is administered.
血小板对氯吡格雷的反应存在个体间的差异,这种差异部分可以用遗传多态性来解释。当氯吡格雷用于急性冠脉综合征(ACS)患者时,这种变异性会影响临床结局。儿茶酚胺在 ACS 期间释放,通过血小板α2A-(α2A-AR)和β2-肾上腺素能受体(β2-AR)的刺激促进血小板聚集。本研究旨在评估α2A-AR 和β2-AR 基因多态性对 ACS 患者接受阿司匹林和氯吡格雷双联抗血小板治疗后血小板反应性的潜在影响。我们对 641 例 ACS 患者进行了 6.3/6.7 kb α2A-AR 多态性和 Arg16Gly 和 Gln27Glu β2-AR 多态性的筛查。给予氯吡格雷 600mg 后,我们评估了 ADP10μmol 诱导的血小板聚集(ADP-Ag)和血管活性刺激磷酸蛋白(VASP)。所有单核苷酸多态性均符合 Hardy-Weinberg 平衡。α2A-AR 的 6.3kb 等位基因与 ADP-Ag 诱导的血小板反应性(β:-2.91[-5.68;-0.14],p=0.04)之间存在微弱但可忽略的关联。在 6.3kbα2A-AR 携带者中,PRIVASP 观察到有边界但无统计学意义的降低(β:-3.81[-0.09;7.72],p=0.06)。其他测试的多态性对血小板参数没有显著影响。当给予 250mg 阿司匹林和 600mg 氯吡格雷双联抗血小板治疗时,常见的α2A-和β2-肾上腺素能受体多态性对非 ST 段抬高型 ACS 中的残余血小板反应性没有显著影响。
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