CYP2C19基因多态性对老年患者椎动脉支架术后不良事件发生情况的影响

Effect of CYP2C19 gene polymorphism on occurrence of adverse events in elderly patients receiving vertebrobasilar artery stenting

目的探讨CYP2C19基因多态性对老年患者椎动脉支架术后不良事件发生的影响。方法回顾性分析2013年2月至2017年3月因缺血性脑卒中于天津医科大学一中心临床学院住院、年龄>60岁且行椎动脉支架术的108例患者的临床资料,根据基因型将患者分为突变型组(46例)和野生型组(62例)。观察2组患者血小板抑制率及不良事件发生情况。采用SPSS 19.0统计软件进行数据分析。根据数据类型,分别采用t检验或χ^(2)检验进行组间比较。对患者再发缺血性脑卒中相关因素进行多因素二元logistic回归分析。结果突变型组血小板抑制率为(54.3±5.6)%,野生型组为(69.7±3.8)%,差异有统计学意义(P<0.001)。突变型组出血发生率为2.2%(1/46),野生型组为4.8%(3/62),差异无统计学意义(P>0.05)。突变型组再发脑梗死发生率为32.6%(15/46),野生型组为4.8%(3/62),差异有统计学意义(P<0.001)。突变型组椎动脉支架内再狭窄发生率为43.5%(20/46),野生型组为11.3%(7/62),差异有统计学意义(P<0.001)。结论老年椎动脉支架术后患者携带CYP2C19突变型基因比野生型有更高的再狭窄、再发缺血性脑卒中风险。CYP2C19基因多态性检测有助于指导用药以降低再发缺血性脑血管事件的发生率。

Objective To explore the effect of CYP2C19 gene polymorphism on occurrence of adverse events in elderly patients receiving vertebrobasilar stenting.Methods A retrospective analysis was made of the clinical data of 108 patients aged over 60 years who were hospitalized for ischemic stroke and underwent vertebral artery stenting in Clinical College of First Center,Tianjin Medical University between February 2013 and March 2017.Patients were divided into mutant group(46 cases)and wild-type group(62 cases)according to genotype.The platelet inhibition rate and adverse events in two groups were observed.SPSS statistics 19.0 was used for statistical analysis.Depending on the data type,t-test orχtest was used for comparison between groups.Multivariate binary logistic regression was performed to analyze factors associated with recurrence of ischemic stroke.Results The platelet inhibition rate in mutant group was(54.3±5.6)%,while in wild-type group was(69.7±3.8)%,and the difference was statistically significant(P<0.001).The incidence of bleeding was 2.2%(1/46)in mutant group and 4.8%(3/62)in wild-type group,with no significant difference between two groups(P>0.05).The incidence of recurrent cerebral infarction was 32.6%(15/46)in mutant group and 4.8%(3/62)in wild-type group,and the difference was statistically significant(P<0.001).The recurrence rate of in-stent restenosis of vertebral artery was higher in the mutant group[43.5%(20/46)]than that of wild-type group[11.3%(7/62)],and the difference was statistically significant(P<0.001).Conclusion Elderly patients with mutant CYP2C19 have a higher risk than wild-type patients for restenosis and recurrent ischemic stroke after vertebral artery stenting.Detection of CYP2C19 genetic polymorphism helps reduce incidence of ischemic cerebrovascular events.