基因检测下氯吡格雷对缺血性卒中二级预防的临床安全性

Analysis of the clinical safety of clopidogrel in the secondary stroke prevention of ischemic stroke on the basis of genetic testing

目的:在基因检测基础上探讨缺血性卒中患者对不同剂量氯吡格雷使用的安全性。方法:在缺血性脑卒中患者中,利用芯片法检测CYP2C19基因型,选取2016年1月至2016年12月200例缺血性卒中患者为研究对象,患者随机分为两组,低剂量组(氯吡格雷50 mg) 97例和高剂量组(氯吡格雷75 mg) 103例。完成24周的疗程,通过观察患者出血情况评定安全性。结果:低剂量组脑出血发生率为8. 0%,高剂量组脑出血发生率为11%,两组比较差异无统计学意义(P> 0. 05)。结论:本研究提示,在检测CYP2C19基因型的前提下,相较于低剂量(50 mg),使用高剂量(75 mg)氯吡格雷对预防缺血性卒中表现更优,建议临床应用推广。

Objective： To observe the clinical safety of different doses of clopidogrel in treatment of patients with ischemic stroke on the basis of genetic testing. Methods： The CYP2C19 genotypes in patients with ischemic stroke were detected by microarray,and a total of 200 patients with ischemic stroke were enrolled in this study. According to the different metabolic methods, the extensive metabolizers and medium metabolizers were randomly divided into the low dose group （97 cases; clopidogrel：50 mg） and high dose group （103 cases; clopidogrel：75 mg）. After 24 weeks of treatment, the bleeding symptom in patients was observed and then the clinical safety was estimated. Results： The incidence of bleeding in low and high dose group was 8.0 % and 11 %, respectively. There was no significant difference after a loading dose of 75 mg or 50 mg of clopidogrel. Conclusion： Under the premise of detecting CYP2C19 genotypes, 75 mg of clopidogrel has more advantages in preventing ischemic stroke than the dose of 50 mg. And the clinical application is recommended.