急性缺血性脑卒中基于CYP2C19基因检测行抗血小板治疗的临床效果

Clinical Efficacy of Antiplatelet Therapy Based on CYP2C19 Gene Detection in Patients With Acute Ischemic Stroke

目的 探讨基因检测必要性,通过行CYP2C19基因检测进一步规范精准实施抗血小板治疗。方法 回顾性调查2022年1月—2023年2月就诊于福建省老年医院神经内科的102例急性缺血性脑卒中患者,均使用氯吡格雷抗血小板治疗,按照是否行CYP2C19基因检测,分为对照组63例,观察组39例;其中观察组行基因检测,并根据基因结果调整抗血小板药物。观察2组进展性脑卒中发生率。结果 2组基线资料比较,差异无统计学意义(P> 0.05);氯吡格雷CYP2C19基因有6种代谢类型,主要突变主体为CYP2C19*2、CYP2C19*3;观察组进展性脑卒中发生率为10.26%,低于对照组的26.98%,差异有统计学意义(P <0.05)。结论 CYP2C19基因检测一定程度预测氯吡格雷抵抗,其中CYP2C19*2、CYP2C19*3易出现氯吡格雷抵抗现象。

Objective To probe the necessity of gene testing about CYP2C19 which is required to further standardize and accurately implement antiplatelet therapy in acute ischemic stroke.Methods A retrospective study was conducted on 102 patients with acute ischemic stroke admitted to the department of neurology,Fujian Provincial Geriatric Hospital from January 2022 to February 2023,all of whom were treated with clopidogrel antiplatelet therapy.All of them were divided into two groups according to whether CYP2C19 gene was performed.There were 63 patients in control group and 39 patients in observation group,the observation group underwent genetic testing and adjusted antiplatelet drugs according to the genetic results.The incidence of progressive stroke was observed in 2 groups.Results There was no statistically significant difference between two groups in baseline comparison(P > 0.05).The CYP2C19 gene of clopidogrel has 6 metabolic types,the main mutations of CYP2C19 gene of clopidogrel are CYP2C19*2 and CYP2C19*3,especially the former.The incidence of progressive stroke in the observation group was 10.26%,lower than 26.98%in the control group,and the difference was statistically significant(P <0.05).Conclusion CYP2C19 gene detection can predict clopidogrel resistance,to a certain extent,CYP2C19*2 and CYP2C19*3 are prone to clopidogrel resistance.