CYP2C19基因多态性对颈动脉支架植入术后支架内血栓形成的影响

Effect of CYP2C19 gene polymorphisms on stent thrombosis after carotid artery stent placement

目的阐明CYP2C19基因多态性与颈动脉支架植入术(CAS)后支架内血栓形成、氯吡格雷抵抗之间的关系。方法入选2013年1月至2014年12月南京医科大学附属脑科医院老年神经科及神经科接受颈内动脉动脉支架(裸支架)植入术的首次住院颈内动脉狭窄患者102例,服用阿司匹林100 mg/d,颈内动脉支架植入术前3 d开始予氯吡格雷75 mg/d口服。多重高温连接酶检测反应进行CYP2C19*2和*3位点分型,并记录氯吡格雷抵抗和支架内血栓形成的发生率。结果入选的102例患者中,按CYP2C19*2分型:CYP2C19*1*1型45例,CYP2C19*1*2型47例,CYP2C19*2*2型10例。携带CYP2C19*2基因者氯吡格雷抵抗的发生率为26.3%(15例),未携带CYP2C19*2基因者氯吡格雷抵抗的发生率为13.3%(6例),组间差异有统计学意义(P<0.05)。携带CYP2C19*2基因者颈内动脉支架植入术后支架内血栓形成的发生率为19.3%(11例),未携带CYP2C19*2基因者支架内血栓形成的发生率为11.1%(5例),组间差异有统计学意义(P<0.05)。结论CYP2C19*2基因位点的多态性可能是颈内动脉支架植入术后不良事件发生的危险因素。

Objective To clarify the relationship of CYP2C19 gene polymorphisms with stent thrombosis and the clopidogrel resistance after carotid artery stent （CAS） placement. Methods One hundred and two patients who firstly underwent carotid artery stent placement from January 2013 to December 2014 were enrolled in the department of neurology and geriatric neurology of Nanjing Brain Hospital. They were treated with aspirin 100 mg/d and clopidogrel 75 mg/d three days before CAS placement.CYP2C19 genotype was detected by improved multiple ligase detection reaction. The incidence rate of clopidogrel resistance and stent thrombosis was observed respectively. Results Of the 102 patients, 45 were wild- type homozygous, 47 were heterozygotes, and 10 were homozygous. The incidence rate of clopidogrel resistance was 26. 3% （ 15 cases） in patients with CYP2C19 ＊ 2 gene, and 13.3% （6 cases） in patients without CYP2C19 ＊ 2 gene, and the difference between two groups was statistically significant （P〈0.05）. The incidence rate of stent thrombosis was 19. 3% （ 11 cases） in patients with CYP2C19 ＊ 2 gene, and 11.1% （5 cases） in patients without CYP2C19 ＊ 2 gene, and the difference between two groups was also statistically significant （P〈 0. 05 ）. Conclusions CYP2C19 ＊ 2 loci polymorphism may be a risk factor for adverse events after CAS placement.