CYP2C19基因多态性与缺血性脑血管病支架术后缺血性事件的相关性研究

Research on Correlation between the CYP2C19 Gene Polymorphism and Ischemic Events after the Ischemic Cerebrovascular Disease Stenting Surgery

目的探讨CYP2C19基因多态性是否为缺血性脑血管病患者支架术后新发脑梗死的独立危险因素。方法前瞻性分析该院2014年1月—2016年12月收治的脑动脉支架植入术患者,检测所有患者CYP2C19*2和*3位点的基因型。患者术后第7天行头颅MRI检查,3个月随访是否新发脑缺血性事件。将患者分为术后新发脑梗死组和非脑梗死组。多因素分析CYP2C19*2和*3位点的基因型是否为新发的独立危险因素。结果纳入104例脑动脉支架术患者,3月随访后未发生脑梗死87例,发生脑梗死患者17例。CYP2C19基因检测,104例患者中快代谢组90例,其中*1/*1 50例,*1/*2 30例,*1/*3 10例,慢代谢患者14例,*2/*2 11例、*2/*3 3例、*3/*3 0例。多因素回归分析发现,除溃疡性斑块及动脉极重度狭窄之外,CYP2C19*2/*2和*2/*3位点基因型也是脑动脉支架术后新发脑梗死的独立危险因素(OR=14.3,95%CI:5.40~47.0)。结论脑动脉支架患者如携带CYP2C19*2/*2和*2/*3位点的基因型可能增加术后新发缺血性事件的风险。

Objective To discuss whether the CYP2C19 gene polymorphism was the independent risk factor of new cerebral infarction after the ischemic events after the ischemic cerebrovascular disease stenting surgery. Methods The patients with cerebral artery stent implantation surgery admitted and treated in our hospital from January 2014 to December 2016 were analyzed and the CYP2C19*2 and *3 genotype of all patients were tested, at 7d after operation, the patients were given the head MRI examination at 7d after operation, and whether the patients were with new cerebral ischemic events or not was followed up after 3 months, and the patients were divided into the new cerebral ischemic group and non-cerebral infarction group, and the multiple factor analysis showed that the CYP2C19*2 and *3 genotype were the independent risk factors of new cerebral arterial thrombosis. Results Of the 104 cases with cerebral artery stenting surgery, there were 87 cases without cerebral infarction and 17 cases with cerebral infarction after 3-month follow-up, and there were 90 patients with fast metabolism, including *1/*1 50 cases, *1/*2 30 cases *1/*3 10 cases, 14 cases with slow metabolism, including *2/*2 11 cases, *2/*3 3 cases, *3/*3 0 case, and the multiple factors regression analysis showed that CYP2C19*2 and *3 genotype were the independent risk factors of new cerebral infarction after the cerebral artery stenting(OR=14.3,95%CI: 5.40~47.0).Conclusion The cerebral artery stenting patients carrying CYP2C19*2/*2 and *2/*3 genotype may increase the risk of new ischemic events after operation.