缺血性脑卒中患者CYP2C19基因多态性与个体化用药的相关性

Correlation between CYP2C19 gene polymorphism and individualized medication in patients with ischemic stroke

目的:探讨根据CYP2C19代谢分型进行的个体化用药调整对于氯吡格雷治疗缺血性脑卒中的指导作用,为临床个体化用药提供参考。方法:纳入80例脑梗死患者,根据是否行CYP2C19基因检测分为经基因检测的个体化用药指导组40例和非基因检测的对照组40例。个体化用药指导组根据CYP2C19代谢分为:慢代谢型、中间代谢型、快代谢型及超快代谢型。快代谢型及超快代谢型按照常规使用氯吡格雷75 mg,每天1次。中间代谢型采用双倍氯吡格雷剂量150 mg,每天1次。慢代谢型患者氯吡格雷更换为替格瑞洛90 mg,每天2次或停用氯吡格雷,改用阿司匹林肠溶片100 mg每天1次;对照组按照常规使用氯吡格雷75 mg,每天1次。对所有入组患者出院后进行为期3个月的门诊或电话随访。比较两组血管事件发生率和改良Rankin量表(mRS)(0-1)发生率。结果:个体化用药指导组血管事件发生率明显低于对照组,mRS评分(0-1)发生率明显高于对照组,差异均有统计学意义(P<0.05)。结论:经CYP2C19基因检测对缺血性脑卒中患者进行的个体化用药,能显著降低血管不良事件发生率,同时对于患者预后生活能力改善也有显著提高。

AIM:To investigate the guiding role of individualized medication adjustment based on CYP2C19 metabolic typing in the treatment of ischemic stroke with clopidogrel,and to provide reference for clinical individualized medication.METHODS:The total of 80 patients with ischemic stroke were divided into the individualized drug instruction group with gene detection(n=40)and the control group without gene detection(n=40)according to whether they received CYP2C19 gene detection.According to the metabolism of CYP2C19,the individualized medication instruction group was divided into slow metabolic type,intermediate metabolic type,fast metabolic type and ultra-fast metabolic type.Patients with fast and ultra-fast metabolites were given clopidogrel dose of 75 mg once a day.Patients with intermediate metabolic type were given double clopidogrel dose of 150 mg once a day.Patients with slow metabolism were given tigrillo dose of 90 mg twice a day or aspirin dose of 100 mg once a day.The control group received 75 mg clopidogrel once a day.All patients enrolled in the groups were followed up for 3 months by outpatients or telephone.The incidence of vascular events and mRS scale scores were compared between the two groups.RESULTS:The incidence of vascular events in the individualized drug instruction group was significantly lower than that in the control group,and the incidence of mRS score(0-1)was significantly higher than that in the control group,with statistically significant differences(P<0.05).CONCLUSION:The individualized medication for patients with ischemic stroke by CYP2C19 gene detection can significantly reduce the incidence of adverse vascular events and improve the prognosis and living ability of patients.