抗血小板药物抵抗的研究进展

Research Progress of Antiplatelet Drug Resistance

目的:抗血小板药物(阿司匹林、氯吡格雷)抵抗是神经介入术后缺血事件再发的重要因素,本文旨在探讨可能导致药物抵抗的风险基因和位点。方法:以神经介入常用的抗血小板药物阿司匹林和氯吡格雷为研究对象,对遗传因素导致的阿司匹林抵抗和氯吡格雷抵抗相关研究进行了整理。结果与结论:阿司匹林抵抗的研究结果间存在争议,目前没有公认的基因位点变异与阿司匹林抵抗相关;CYP2C19弱代谢是氯吡格雷抵抗的重要因素,但CYP2C19仅能解释约12%的药物抵抗,因此临床并不推荐常规进行该基因的检测,氯吡格雷抵抗的主要因素仍在研究当中。此外,当前的研究多集中于心血管病患者,在脑血管病患者中药物抵抗的研究有待加强。

OBJECTIVE： Antiplatelet drugs（ aspirin,clopidogrel） resistance is an important factor in the recurrence of ischemic events after neurosurgical interventions. This article aims to probe into the genetic risks and locus which may cause drug resistance. METHODS： The frequently-used antiplatelet drugs in the neurosurgical intervention,aspirin and clopidogrel were set as study objects. Correlational studies on aspirin and clopidogrel resistance caused by genetic factors were settled. RESULTSCONCLUSIONS： Result of aspirin resistance remained controversial, and there was no recognized genetic locus variation associated with aspirin resistance. The poor metabolism of CYP2C19 was an important factor of clopidogrel resistance,yet CYP2C19 can only explain about 12% of the drug resistance. Therefore,routine testing of CYP2C19 genetic polymorphism was not recommended in clinical practice. Researches on factors leading to clopidogrel resistance are still in active. In addition,current studies mainly focus on patients with cardiovascular diseases,therefore,researches on drugs resistance of patients with cerebrovascular diseases need to be reinforced.