新疆地区汉族与维吾尔族急性轻型缺血性卒中或短暂性脑缺血发作患者的CYP2C19基因多态性和预后

CYP2C19 gene polymorphism and prognosis of Han and Uygur patients with acute mild ischemic stroke or transient ischemic attack in Xinjiang

目的探讨新疆地区汉族与维吾尔族急性轻型缺血性卒中或短暂性脑缺血发作(TIA)患者的CYP2C19基因多态性和预后。方法选取新疆维吾尔自治区人民医院2018年1月至2019年12月收治的急性轻型缺血性卒中和TIA患者171例,其中汉族89例、维吾尔族82例。患者入院后均给予阿司匹林100 mg/d联合氯吡格雷75 mg/d口服治疗,3周后停用氯吡格雷,维持阿司匹林100 mg/d,共90 d。比较不同民族患者的年龄、性别、高血压病史、糖尿病史、吸烟史、饮酒史,血清总胆固醇、三酰甘油、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇水平,CYP2C19基因型和代谢型分布情况,以及不同基因代谢型患者的预后。结果不同民族患者基线临床资料和血脂水平比较差异均无统计学意义(均P>0.05)。汉族患者CYP2C19基因型分布与维吾尔族比较差异无统计学意义(P>0.05),但快代谢型比例低于维吾尔族、中等代谢型比例高于维吾尔族[41.6%(37/89)比61.0%(50/82)、48.3%(43/89)比30.7%(26/82)](均P<0.05)。汉族快代谢型、中等代谢型和慢代谢型患者新发卒中和TIA、非致死性心肌梗死、血管性死亡发生率与维吾尔族比较差异均无统计学意义(均P>0.05)。结论新疆地区汉族、维吾尔族急性轻型缺血性卒中和TIA患者的CYP2C19基因型分布差异无统计学意义,但代谢型分布差异有统计学意义,其中快代谢型中维吾尔族比例更高,而中等代谢型中汉族比例更高,但在急性期给予相同双联抗血小板治疗后序贯给予单一阿司匹林治疗,预后情况民族差异无统计学意义。

Objective To investigate the CYP2C19 gene polymorphism and prognosis in patients with acute mild ischemic stroke or transient ischemic attack( TIA) between Han and Uygur in Xinjiang. Methods Totally171 patients with acute ischemic stroke or TIA admitted to People’s Hospital of Xinjiang Uygur Autonomous Region from January 2018 to December 2019 were selected,including 89 Han patients and 82 Uygur patients. All patients were given aspirin 100 mg/d combined with clopidogrel 75 mg/d orally after admission. Clopidogrel was stopped after 3 weeks and aspirin 100 mg/d was maintained for 90 d. The age,gender,hypertension history,diabetes mellitus history,smoking history,drinking history,serum total cholesterol,three acylglycerol,low-density lipoprotein cholesterol,high-density lipoprotein cholesterol,CYP2C19 genotype and metabolic distribution between Han and Uygur patients were compared. The prognosis of patients with different genotype were compared. Results There was no significant difference in baseline clinical data and the level of blood lipid between patients of the two nationalities( all P > 0. 05). There was no significant difference in the distribution of CYP2C19 genotype between Han and Uygur patients( P > 0. 05),but the proportion of fast metabolic type in Han patients was lower than that in Uygur patients,and the proportion of medium metabolic type in Han patients was higher than in Uygur patients[41. 6%( 37/89) vs 61. 0%( 50/82),48. 3%( 43/89) vs 30. 7%( 26/82) ]( both P < 0. 05). There were no significant differences in the incidences of new stroke,TIA,nonfatal myocardial infarction and vascular death between Han and Uygur patients in fast and medium metabolic types( all P > 0. 05). Conclusions There is no difference in the distribution of CYP2C19 genotype between Han and Uygur patients with acute ischemic stroke or TIA in Xinjiang,but there is significant difference in the distribution of metabolic types. Among them,the proportion of Uygur in fast metabolic type is higher,and the proportion of Han in medium metabolic type is higher. However,after the same dual antiplatelet therapy in the acute phase and single aspirin treatment sequentially,there was no significant difference in prognosis.