CYP2C19基因多态性与急性脑梗死患者中氯吡格雷抗血小板效果的分析

Analysis of CYP2C19 gene polymorphism and antiplatelet effect of clopidogrel in patients with acute cerebral infarction

目的通过PFA-200 P2Y法、吸光度比浊法(LTA)检测血小板功能,探讨CYP2C19基因多态性与急性期脑梗死患者临床相关因素及与氯吡格雷临床疗效的关系。方法回顾性研究分析2018年1月至2018年12月就诊于本院的72例急性期脑梗死患者的临床资料,患者均进行CYP2C19基因型检测,根据CYP2C19基因型结果分为快代谢组(EM组,n=27)、中间代谢组(IM组,n=32)、慢代谢组(PM组,n=13)。所有患者口服氯吡格雷3 d后,采用PFA-200 P2Y、LTA检测血小板功能,并收集患者基本资料、现病史、既往史、临床用药、实验室检查信息。分析CYP2C19基因多态性与血小板功能检测结果、CR(氯吡格雷抵抗)发生率及住院时间的关系。结果 PFA-200 P2Y检测结果显示,EM组患者血小板功能闭合时间长于IM组和PM组(P<0.05),LTA检测血小板聚集率显示,EM组低于IM组和PM组(P<0.05)。PFA-200 P2Y和LTA检测显示,3组CR发生率比较差异有统计学意义(P<0.05)。PFA-200 P2Y法与LTA法检测方法结果呈负相关性(r=-0.365,P=0.001)。3组患者住院时间比较差异无统计学意义。结论约62.5%的急性期脑梗死患者携带CYP2C19功能基因缺失。PFA-200 P2Y法、LTA法检测的血小板功能显示CYP2C19基因多态性和氯吡格雷疗效有明显相关性。

Objective To detect platelet function by PFA-200 P2Y method and absorbance turbidimetry(LTA),and to explore the relationship between CYP2C19 gene polymorphism and clinical related factors in patients with acute cerebral infarction and clinical efficacy of clopidogrel.Methods Clinical data of 72 patients with acute cerebral infarction admitted to our hospital from January 2018 to December 2018 were retrospectively analyzed.All patients underwent CYP2C19 genotype test,and were divided into fast metabolic group(EM group,n=27),intermediate metabolic group(IM group,n=32),and slow metabolic group(PM group,n=13)according to the results of CYP2C19 genotype.PFA-200 P2Y and LTA were used to detect platelet function of all patients after oral administration of clopidogrel for 3 days.General information,history of present disease,past history,clinical medication and laboratory examination information of all patients were collected.The relationship between CYP2C19 gene polymorphism and platelet function test results,CR(clopidogrel resistance)incidence and length of hospital stay was analyzed.Results The results of PFA-200 P2Y test showed that the platelet function closure time of EM group was longer than that of IM group and PM group(P<0.05).The platelet aggregation rate of LTA test showed that EM group was lower than IM group and PM group(P<0.05).PFA-200 P2Y and LTA tests showed that there was statistically significant difference in the incidence of CR among the three groups(P<0.05).The results of PFA-200 P2Y method and LTAmethod were negatively correlated(r=-0.365,P=0.001).There was no significant difference in the length of stay between the three groups.Conclusion About 62.5%patients with acute cerebral infarction carry CYP2C19 functional gene deletion.The platelet function detected by PFA-200 P2Y method and LTA method showed significant correlation between CYP2C19 gene polymorphism and clopidogrel efficacy.