急性脑梗死患者CYP2C19基因多态性与纤维蛋白原及D-二聚体相关性研究

Correlation study between CYP2C19 gene polymorphisms and levels of FIB and D-Dimer in patients with acute cerebral infarction

目的探讨急性脑梗死患者细胞色素P450酶等位基因(CYP2C19基因)多态性与纤维蛋白原(FIB)及D-二聚体相关性。方法选取常规服用氯吡格雷超过1个月的急性脑梗死患者112例为研究对象,采用RT-PCR法检测脑梗死患者外周全血CYP2C19基因型,运用凝固法(Clauss法)检测FIB,透射比浊法检测血浆中D-二聚体。结果112例急性脑梗死患者中快代谢型(快代谢组,CYP2C19*1/*1)患者较多,为46例,占比41.1%;中代谢型(中代谢组,CYP2C19*1/*2、CYP2C19*1/*3)为41例,占比36.6%;慢代谢型(慢代谢组,CYP2C19*2/*2、CYP2C19*2/*3)最少,为25例,占比22.3%。慢代谢组FIB及D-二聚体水平高于快代谢组及中代谢组,差异有统计学意义(P<0.05)。CYP2C19基因型与FIB及D-二聚体呈正相关(r=0.129、0.158,P<0.05)。结论CYP2C19基因型与FIB和D-二聚体具有一定相关性,使用常规剂量的氯吡格雷治疗CYP2C19基因慢代谢型急性脑梗死患者,可能增加血栓风险,可考虑更换新的药物或增加剂量进行治疗。

Objective To explore association between cytochrome P450 enzyme allele(CYP2C19)gene polymorphisms and levels of fibrinogen(FIB)and D-Dimer in patients with acute cerebral infarction.Methods Totally 112 cases of patients with acute cerebral infarction who had taken clopidogrel regularly for more than 1 month were selected.Real time fluorescent quantitative PCR was used to detected CYP2C19 genotype.Clauss and transmission turbidimetry method were used to detected the plasm FIB and D-Dimer.Results Totally 46 patients were extensive metabolism type(EM group,CYP2C19*1/*1),which accounted for 41.1%.And totally 41 patients were intermediate metabolism type(IM group,CYP2C19*1/*2,CYP2C19*1/*3),which accounted for 36.6%.There were only 25 patients with poor metabolism type(PM group,CYP2C19*2/*2,CYP2C19*2/*3),which accounted 22.3%.Levels of FIB and D-Dimer of PM group were significantly higher than that of IM and EM group(P<0.05).It showed that there were positive correlations between CYP2C19 genotype with FIB and D-Dimer(r=0.129,0.158,P<0.05).Conclusion CYP2C19 genotype has some correlation with FIB and D-Dimer,acute cerebral infarction patients with CYP2C19 poor metabolism type have an increased risk of thrombosis when treated with conventional clopidogrel doses.It could be considered to replace the new drugs or increase the dosage for treatment.