氯吡格雷联合拜阿司匹林对脑梗死的疗效及与FⅫ基因46C/T多态性分布的相关性分析

Clinical efficacy of clopidogrel combined with aspirin on cerebral infarction and its correlation with 46C/T polymorphism of FⅫ gene

目的探讨脑梗死应用氯吡格雷联合拜阿司匹林的临床效果及FⅫ基因46C/T多态性与其相关性。方法选择2017-05—2018-01入院治疗的脑梗死患者120例,根据治疗方法分为对照组(60例)和观察组(60例);选择同期入院健康体检者60例,设为空白对照组。对照组采用奥扎格雷钠、低分子肝素钠、拜阿司匹林治疗,观察组在对照组基础上联合氯吡格雷治疗,2组均连续治疗14d。直接采用测序法检测观察组、对照组、空白对照组FⅫ基因启动区46位碱基多态性;采用一期凝固法测定血浆凝血因子XII活性(FⅫ:C);采用美国国立卫生研究院卒中量表(NIHSS)评分对2组治疗前、治疗后14d神经缺损进行评估;采用Barthel指数对2组治疗前、治疗后14d日常生活能力进行评估;采用日常活动能力缺损评分(ADL)对2组治疗前、治疗后14d生活质量进行评估,观察2组临床疗效及与FⅫ基因46C/T多态性的相关性。结果观察组与对照组FⅫ基因46C/T、C/C型分布频率,高于空白对照组(P<0.05);观察组与对照组46T/T多态性、T等位基因与C等位基因,均高于空白对照组(P<0.05);观察组、对照组46T/T、46C/T、46C/C级总体水平,均低于空白对照组(P<0.05);观察组治疗后14dNIHSS评分,低于对照组(P<0.05);观察组治疗后14dBarthel指数及ADL评分,均高于对照组(P<0.05)。结论脑梗死患者FⅫ基因46C/T多态性能引起FⅫ血浆水平降低,且46T/T或T等位基因为易感因素,加强氯吡格雷联合拜阿司匹林治疗有助于减少神经损伤,提高患者日常生活能力。

Objective To explore the clinical effect of clopidogrel combined with the clinical effects of clopidogrel and 46C/T polymorphism of FXII gene.Methods 120 patients with cerebral infarction admitted to hospital from may,2017 to January,2018 were selected as control group(n=60 cases)and observation group(n=60 cases).In the same period,60 patients were admitted to the hospital with a blank control group.The 46 base polymorphism of FXII gene promoter region in the control group and the control group were detected by direct sequencing.XII activity of plasma coagulation factor(FXII:C)was determined by phase I coagulation method.The control group was treated with ozargrel sodium,low molecular weight heparin sodium,and aspirin treatment.The observation group was treated with clopidogrel on the basis of the control group,and both groups were treated with continuous treatment of 14d.Using the national institutes of health stroke scale(NIHSS)scale score,the patients were evaluated before and after treatment for 14d after treatment.Barthel index was used to evaluate the daily life ability of the two groups before and after treatment.The quality of life of the two groups before and after treatment was evaluated,and the clinical efficacy of the two groups and the correlation of FXII gene 46C/T polymorphism were observed.Results The distribution frequency of FXII gene 46C/T and C/C in the observation group and control group was higher than that in the blank control group(P<0.05).Both the observation group and the control group of 46T/T polymorphism,T allele and C allele were all higher than the blank control group(P<0.05).The total level of 46T/T,46C/T and 46C/C in the observation group and the control group was lower than the control group(P<0.05).In the observation group,14d NIHSS score was lower than the control group(P<0.05).In the observation group,14d Barthel index and ADL score were higher than the control group(P<0.05).Conclusion The patients with cerebral infarction FXII 46 c/T polymorphism gene can cause FXII plasma levels drop,and 46 T/T or T allele for susceptible factors,strengthen the clopidogrel in combination with aspirin therapy helps reduce nerve injury,improve the ability of patients daily life.