颅内动脉瘤患者氯吡格雷治疗后发生脑血管事件的风险因素分析

Risk factors of major adverse cerebrovascular events in intracranial aneurysms patients treated with clopidogrel

目的探讨颅内动脉瘤患者支架辅助栓塞术(SAC)后应用氯吡格雷治疗发生主要不良脑血管事件(MACE)的影响因素。方法 229例颅内动脉瘤SAC后服用氯吡格雷并随访6个月的患者,检测CYP2C19基因多态性。根据临床结局分为发生MACE组(n=22)和未发生MACE组(n=207),比较两组患者一般临床资料、实验室指标、手术资料和CYP2C19基因型,多因素Logistic回归分析MACE的影响因素。结果 229例患者MACE的发生率为9.6%。多因素Logistic回归分析结果显示CYP2C19慢代谢型(OR=2.125,95%CI:1.127~4.006,P=0.020)、糖尿病(OR=5.767,95%CI:1.139~18.434,P=0.003)、白细胞计数(OR=2.908,95%CI:1.139~7.420,P=0.026)、C-反应蛋白(OR=3.441,95%CI:1.318~8.983,P=0.012)为MACE的独立风险因素。结论 CYP2C19基因型、糖尿病、C-反应蛋白和白细胞计数升高为颅内动脉瘤患者支架辅助栓塞术后氯吡格雷治疗发生MACE的危险因素。

AIM To explore the risk factors of major adverse cerebrovascular events （MACE） after stent-assisted coiling （SAC） for intracranial aneurysms patients treated with clopidogrel. METHODS A total of 229 intracranial aneurysms patients after SAC treated with clopidogrel for 6 months were enrolled, and CYP2C19 gentypes were detected. According to pre-designed outcome, patients were divided into MACE group （n = 22） and without MACE group （n = 207）, respectively. Baseline clinical features, CYP2C19 genotypes and operative data were done in patients with MACE versus those without, and the independent risk factors of MACE were explored by Logistic regression analysis. RESULTS The incidence of MACE in all 229 patients was 9.6% during the follow up of 6 months. Logistic analysis showed that MACE was related with CYP2C19 poor metabolizers （OR = 2.125, 95%CI： 1.127-4.006, P = 0.020）, diabetes mellitus （OR = 5.767, 95%CI： 1.139-18.434, P= 0.003）, leukocyte counts （OR = 2.908, 95%CI： 1.139-7.420, P = 0.026）, and Creactive protein （OR = 3.441, 95%CI： 1.318-8.983, P = 0.012）. CONCLUSION CYP2C19 genotypes, diabetes, increased levels of leukocyte counts and C- reactive protein might contribute to MACE after SAC in patients with intracranial aneurysms.