CYP2C19基因多态性联合DSA评估氯吡格雷与阿司匹林治疗急性脑梗死的疗效

Value of CYP2C19 gene polymorphism combined with DSA in the prediction of therapeutic efficacy of clopidogrel combined with aspirin on acute cerebral infarction

目的探讨CYP2C19基因多态性联合DSA评估氯吡格雷与阿司匹林双抗血小板(DAPT)治疗急性脑梗死(ACI)患者的临床疗效及预后。方法选取2021-06-2022-06保定市第一中心医院收治的60例ACI患者,均于入院时行CYP2C19基因多态性检测及颅脑数字减影血管造影(DSA),均给予静脉溶栓及氯吡格雷联合阿司匹林DAPT治疗。比较不同疗效及预后ACI患者的临床资料,分析相关因素对DAPT疗效及ACI患者预后的影响及其预测价值。结果不同疗效ACI患者在年龄、发病时间、入院美国国立卫生研究院卒中量表(NIHSS)评分、CYP2C19基因型及责任血管狭窄程度方面均存在统计学差异(分别为t=2.786,P=0.008;t=4.680;P<0.001;t=3.942,P<0.001;χ^(2)=10.304,P=0.006;t=10.304,P=0.006);不同预后ACI患者在年龄、发病时间、入院NIHSS评分、合并糖尿病、CYP2C19基因型及责任血管狭窄程度方面均有统计学差异(t=3.266,P=0.002;t=3.208,P=0.002;t=2.129,P=0.041;χ^(2)=9.974,P=0.002;χ^(2)=14.752,P=0.001;t=2.074,P=0.043)。发病时间长、入院NIHSS评分高、CYP2C19基因慢代谢型及责任血管狭窄程度高均是DAPT临床疗效不佳的独立危险因素(P<0.05),而入院NIHSS评分高、合并糖尿病、CYP2C19基因慢代谢型及责任血管狭窄程度高均是ACI患者预后不良的独立危险因素(P<0.05)。责任血管狭窄程度预测DAPT临床疗效及ACI患者预后的AUC均>0.7。结论ACI患者疗效及预后均与CYP2C19基因多态性、入院DSA检测结果密切相关,可联合CYP2C19基因型与DSA检测预估疗效及预后。

Objective To explore the value of CYP2C19 gene polymorphism combined with DSA in evalu⁃ating the clinical efficacy and prognosis of clopidogrel combined with aspirin dual antiplatelet therapy(DAPT)in patients with acute cerebral infarction(ACI).Methods Sixty patients with ACI admitted to Baoding First Cen⁃tral Hospital from June 2021 to June 2022 were selected.All of them were tested for CYP2C19 gene polymor⁃phism and brain digital subtraction angiography(DSA)at admission,and were given intravenous thrombolysis and clopidogrel combined with aspirin DAPT.The clinical data of ACI patients with different curative effects and prog⁃nosis were compared,and the influence and predictive value of relevant factors on the curative effect of DAPT and the prognosis of ACI patients were analyzed.Results ACI patients with different curative effects had significant differences in age,onset time,admission NIHSS score,CYP2C19 genotype and degree of responsible vascular stenosis(t=2.786,P=0.008;t=4.680;P<0.001;t=3.942,P<0.001;χ^(2)=10.304,P=0.006;t=10.304,P=0.006);ACI patients with different prognosis had significant differences in age,onset time,admission NIHSS score,combined with diabetes,CYP2C19 genotype and the degree of responsible vascular stenosis(t=3.266,P=0.002;t=3.208,P=0.002;t=2.129,P=0.041;χ^(2)=9.974,P=0.002;χ^(2)=14.752,P=0.001;t=2.074,P=0.043).Long onset time,high NIHSS score,CYP2C19 slow metabolism and high degree of responsible vascular stenosis were independent risk factors for poor clinical efficacy of dapt(P<0.05),while high NIHSS score,combined with diabetes,CYP2C19 slow metabolism and high degree of re⁃sponsible vascular stenosis were independent risk factors for poor prognosis of ACI patients(P<0.05).The AUC of predicting the clinical ef⁃ficacy of dapt and the prognosis of ACI patients by the degree of responsible vascular stenosis was>0.7.Conclusion The curative ef⁃fect and prognosis of ACI patients are closely related to CYP2C19 gene polymorphism and the results of admission DSA detection.CYP2C19 genotype and DSA detection can be combined to predict the curative effect and prognosis.