目的 分析注射用丹参多酚酸联合双联抗血小板药物对CYP2C19基因变异的颈动脉支架植入术后患者的治疗作用。方法 选取河南大学第一附属医院2014年1月-2017年8月96例CYP2C19基因突变且植入颈动脉支架的患者为研究对象，抽签随机分为丹参多酚组与对照组，每组48例。对照组患者术后接受双联抗血小板（阿司匹林100 mg qd+氯吡格雷75mg qd）+降脂（阿托伐他汀钙片20 mg qn）治疗，丹参多酚组除上述治疗外，术前iv注射用丹参多酚酸0.13 g，术后每日1次，每次0.13 g，共应用14 d。观察两组治疗前及治疗后超敏C反应蛋白（hs-CRP）、白介素-6（IL-6）、肿瘤坏死因子-α（TNF-α）、内皮素-1（ET-1）、丙二醛（MDA）、一氧化氮（NO）、超氧化物歧化酶（SOD）、亲环素A（CyPA）、8异前列腺素F2α（8-iso-PGF2α）水平。术后随访1年，记录主要负性临床事件。结果 治疗前两组上述指标无统计学差异；治疗后两组NO、SOD高于治疗前，hs-CRP、IL-6、TNF-α、ET-1、MDA、CyPA、8-iso-PGF2α均低于治疗前，同组治疗前后比较差异有统计学意义（P<0.05）；且治疗后丹参多酚组NO、SOD高于对照组，hs-CRP、IL-6、TNF-α、ET-1、MDA、CyPA、8-iso-PGF2α低于对照组，组间差异有统计学意义（P<0.05）。丹参多酚组随访期间主要负性临床事件显著低于对照组，差异有统计学意义（P<0.05）。结论 注射用丹参多酚酸联合双联抗血小板治疗能够为CYP2C19基因变异的颈动脉狭窄患者在颈动脉支架植入术后提供更好的内皮功能改善，更大程度地缓解炎症及氧化应激状态，降低主要负性临床事件发生风险。

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.

河南省教育厅科学技术研究重点项目（18A310012）