基于CYP2C19基因指导抗血小板治疗对不同民族缺血性卒中患者的临床疗效研究

Study on the Clinical Efficacy of Antiplatelet Therapy Guided by CYP2C19 Gene Detection in Ischemic Stroke Patients of Different Ethnic Groups

目的分析不同民族缺血性卒中患者对基于快速细胞色素P450酶家族2亚家族C成员19(cytochrome P450 family 2 subfamily C member 19,CYP2C19)基因检测指导抗血小板治疗方案的反应差异。方法前瞻性连续纳入2023年1—7月在南宁市第三人民医院住院治疗的汉族(对照组)和壮族(试验组)非心源性轻型缺血性卒中患者。所有患者在CYP2C19基因检测结果指导下进行抗血小板治疗:对于基因表型为氯吡格雷快代谢的患者,抗血小板药物选择硫酸氢氯吡格雷;对于中间代谢或慢代谢的患者,抗血小板药物选择阿司匹林肠溶片或替格瑞洛片。随访90 d,记录mRS评分、日常生活能力量表(activity of daily living scale,ADL)评分、NIHSS评分以及90 d缺血性卒中累积复发率。结果共纳入1036例缺血性卒中患者,对照组743例,CYP2C19基因检测结果显示,氯吡格雷快代谢、中间代谢、慢代谢型患者分别为299例(40.24%)、345例(46.43%)和99例(13.32%)。试验组293例,氯吡格雷快代谢、中间代谢、慢代谢型患者分别为107例(36.52%)、161例(54.95%)和25例(8.53%)。两组不同CYP2C19基因表型的比例差异无统计学意义。随访90 d,两组间的mRS评分、ADL评分、NI HSS评分差异无统计学意义。对照组和试验组的90 d缺血性卒中累积复发率分别为5.52%(41/743)和5.12%(15/293),差异无统计学意义。结论基于CYP2C19基因检测指导的抗血小板治疗在汉族和壮族的缺血性卒中患者人群中,预防缺血性卒中复发的效果相似。

Objective To analyze the difference in response of antiplatelet therapy guided by cytochrome P450 family 2 subfamily C member 19(CYP2C19)gene detection in ischemic stroke patients of different ethnic groups.Methods The prospective study consecutively included Han(the control group)and Zhuang(the experimental group)patients with non-cardiogenic mild ischemic stroke who were hospitalized for treatment at the Third People’s Hospital of Nanning from January to July 2023.All patients were administered antiplatelet therapy,with the choice of medication guided by CYP2C19 gene detection results.Fast metabolizers were given clopidogrel bisulfate,while intermediate or slow metabolizers were given enteric-coated aspirin or ticagrelor.A follow-up period of 90 days was established to record the mRS scores,activity of daily living scale(ADL)scores,NIHSS scores,and the cumulative recurrence rates of ischemic stroke at 90 days.Results A total of 1036 patients with ischemic stroke were included,with 743 in the control group.The results of the CYP2C19 gene detection showed that there were 299(40.24%)fast metabolizers,345(46.43%)intermediate metabolizers,and 99(13.32%)slow metabolizers of clopidogrel.In the experimental group,there were 293 patients,with 107(36.52%)fast metabolizers,161(54.95%)intermediate metabolizers,and 25(8.53%)slow metabolizers of clopidogrel.The differences in the proportion of different CYP2C19 genotypes between the two groups were not statistically significant.After a 90 days follow-up,there was no significant difference in mRS scores,ADL scores,and NIHSS scores between the two groups.The cumulative recurrence rates of ischemic stroke at 90 days for the control group and the experimental group were 5.52%(41/743)and 5.12%(15/293),respectively,with no statistically significant difference.Conclusions Antiplatelet therapy guided by CYP2C19 gene detection has similar effects in preventing the recurrence of ischemic stroke in Han and Zhuang patients.