摘要
目的:探讨CYP2C19基因功能丧失(LOF)等位基因携带者服用氯吡格雷治疗脑梗死时,与LOF程度相关的氯吡格雷抵抗(CR)率和血小板抑制率之间的关系,以提供临床个体化用药的参考依据。方法:回顾性分析了2019年1月—2020年12月接受治疗的107例脑梗死患者。根据基因分型,携带2个^(*)2或^(*)3等位基因的(^(*)2/^(*)2、^(*)2/^(*)3或^(*)3/^(*)3)列入慢代谢组;携带1个^(*)2或^(*)3等位基因的(^(*)1/^(*)2、^(*)1/^(*)3)列入中间代谢组;没有携带^(*)2或^(*)3等位基因的(^(*)1/^(*)1)列入快代谢组。比较三组血小板抑制率及CR率。结果:(1)经CYP2C19基因检测,快代谢组39例,占36.45%;中间代谢组58例,占54.21%;慢代谢组10例,占9.35%。(2)快代谢组的血小板抑制率明显高于中间代谢组和慢代谢组,而CR率则显著低于中间代谢组和慢代谢组,差异均具有统计学意义(P<0.05);中间代谢组、慢代谢组的血小板抑制率和CR率差异均无统计学意义(P>0.05)。(3)1年内,N-LOF组和LOF组脑梗死复发率分别为12.8%和30.9%,差异具有统计学意义(P<0.05)。结论:服用氯吡格雷的脑梗死患者,CYP2C19 LOF携带者血小板抑制率降低,CR率增加,且与携带CYP2C19 LOF等位基因程度无关。
Objective:To investigate the relationship between the degree of CYP2C19 LOF and clopidogrel inhibition rate and clopidogrel resistance(CR)rate in patients with cerebral infarction,so as to provide reference for clinical individual medication.Methods:A total of 107 patients with cerebral infarction treated in our hospital from January 2019 to December 2020 were selected and analyzed retrospectively.According to genotyping,those carrying two^(*)2 or^(*)3 alleles(^(*)2/^(*)2、^(*)2/^(*)3 or^(*)3/^(*)3)were classified as poor metabolizers group;those with one^(*)2 or^(*)3 allele(^(*)1/^(*)2 or^(*)1/^(*)3)were classified as intermediate metabolic group,and those without^(*)2 or^(*)3 allele(^(*)1/^(*)1)were classified as extensive metabolic group.The platelet inhibition rate and clopidogrel resistance rate were compared among the three groups.Results:(1)There were 39 patients(36.45%)in the extensive metabolic group,58 patients(54.21%)in the intermediate metabolic group,and 10 patients(9.35%)in the poor metabolizers group according to CYP2C19 genotyping.(2)Compared with the extensive metabolic group,the platelet inhibition rates in the intermediate metabolic group and the poor metabolizers group were significantly decreased,and the rates of clopidrogel resistance were significantly increased(P<0.05).There was no statistical significance between the intermediate metabolic group and the poor metabolizers group in platelet inhibition rates and clopidogrel resistance rates(P>0.05).(3)Within one year,the recurrence rate of cerebral infarction in N-LOF group and LOF group was 12.8%and 30.9%respectively,the difference was statistically significant(P<0.05).Conclusion:Among patients with cerebral infarction,the platelet inhibition rate decreased and clopidogrel resistance increased in CYP2C19 LOF carriers,and those are not consistent with the degree of CYP2C19 LOF.
作者
张富丽
管海波
ZHANG Fuli;GUAN Haibo(The Fifth Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,Henan,China)
出处
《医学理论与实践》
2025年第22期3806-3809,共4页
The Journal of Medical Theory and Practice
