急性脑梗死患者血栓弹力图与CYP2C19基因多态性对氯吡格雷疗效评价的关系

Relationship between thromboelastography and CYP2C19 gene polymorphism in evaluating the efficacy of clopidogrel in patients with acute cerebral infarction

目的 探讨急性脑梗死(ACI)患者血栓弹力图(TEG)与CYP2C19基因多态性对氯吡格雷疗效评价的一致性。方法 选择2020年10月至2020年12月徐州医科大学附属宿迁医院神经内科收治的128例ACI患者,检测所有患者TEG与CYP2C19基因多态性对氯吡格雷的评价。采用Cohen`s kappa系数分析TEG与CYP2C19基因多态性对氯吡格雷评价的相关性。结果 依据TEG检测血小板抑制率和CYP2C19*2/*3基因型指导的氯吡格雷正常剂量(75 mg/d)治疗有16位患者,增加剂量/更换药物治疗有59位,TEG建议正常剂量治疗而基因学检测推荐增加剂量/更换药物有7位,TEG建议增加剂量/更换药物而基因学检测建议正常剂量用药有46位。两种方法间差异具有统计学意义(χ^(2)=5.011,P <0.05),评估结果一致性较差Cohen`s kappa=0.155(K <0.20)。结论 TEG与CYP2C19基因多态性对氯吡格雷疗效评价的一致性较差,两种方法间无法替代。

Objective To investigate the consistency between the thromboelastography(TEG) and CYP2C19 gene polymorphism of patients with acute cerebral infarction(ACI) in evaluating the efficacy of clopidogrel. Methods 128 ACI patients admitted to the department of neurology,The Affiliated Suqian Hospital of Xuzhou Medical University from October 2020 to December 2020 were selected as subjects. Detecting efficacy of clopidogrel in subjects by the TEG and CYP2C19 gene polymorphism. Cohen`s kappa coefficient was used to analyze the correlation between TEG and CYP2C19 gene polymorphism evaluate clopidogrel. Results According to TEG in detecting platelet inhibition and CYP2C19 genotype guidance, 16 patients were treated with 75 mg/d of clopidogrel,and 59 patients were treated with increased dose or drug replacement. 7 patients were recommended normal treatment by TEG, but were suggested increased does/replacement of drugs by genetic testing. 46 patients were recommended increased dose/replacement of drugs by TEG, but normal doses by genetic testing. The difference between the two methods was statistically significant(χ^(2)=5.011, P < 0.05), and the consistency of the evaluation results was poor(Cohen`s kappa=0.155, K < 0.20). Conclusion TEG and CYP2C19 gene polymorphisms have poor consistency in evaluating the efficacy of clopidogrel, and there is no substitute between the two methods.