脑梗死患者P2Y12与CYP2C19基因突变的临床学特征及其与氯吡格雷动态抵抗的相关性  

Analysis of clinical characteristics of P2Y12 and CYP2C19 mutation genes and their relationship with the incidence of dynamic clopidogrel resistance in patients after cerebral infarction

作　　者：石红婷[1] 周伯荣[2] 王融[3] 邓燕华[2] 关海涛[2] 刘子凡[2] 

机构地区：[1]广州医科大学附属第四医院神经内科,广东广州511447 [2]广州医科大学附属第三医院神经内科,广东广州510150 [3]广州医科大学附属第三医院检验科,广东广州510150

出　　处：《中风与神经疾病杂志》2014年第10期871-875,共5页Journal of Apoplexy and Nervous Diseases

基　　金：广东省科技计划项目;批文号:粤科计字(2008)146号

摘　　要：目的本研究探讨P2Y12、CYP2C19基因突变的临床学特征、以及在脑梗死患者中P2Y12与CYP2C19基因突变与DCR发生的相关性。方法收集脑梗死患者121例,将患者分为CR组（clopidogrel resistance,CR）与NCR组（none CR,NCR）,NCR分为DCR组（dynamic CR,DCR）与CNCR组（continuous NCR,CNCR）,同时按是否携带P2Y12εC或CYP2C19εA,分为两组;按共存基因分为4组。分别测定所有患者服药前、给药后2 w的血小板聚集率（Platelet aggregation rate,PAR）,且NCR组的患者进一步测定3 m及6 m的PAR。结果 LDL-C（OR=3.581,95%CI 2.070-6.195,P〈0.0001）为P2Y12εC的临床学特征;甘油三脂（OR=2.812,95%CI 1.498-5.281,P=0.001）及糖化血红蛋白（OR=2.327,95%CI 1.231-4.398,P=0.009）为CYP2Y19εA的临床学特征。在CR或DCR组,携带CYP2Y19εA和共存P2Y12εC与CYP2Y19εA的发生率高于NCR或CNCR组（P〈0.05）。结论在脑梗死患者中,LDL-C是P2Y12εC的临床学特征,同样甘油三酯和糖化血红蛋白是CYP2C19εA的临床学特征,提示调节血脂代谢和控制糖尿病可能在预防DCR发生中具有积极作用。Objective To analyze clinical characteristics of P2Y12 and CYP2C19 mutation genes and their relationship with the incidence of dynamic clopidogrel resistance in secondary prevention of cerebral infarction（ CI）. Methods The study included 147 cases of CI,the CI were respectively divided into 2 groups according to the presence or absence of carriers the C of P2Y12（ P2Y12εC） or carriers the A of CYP2C19（ CYP2C19εA）. According to coexisting genes,patients were divided into 4 subgroups. The patients were further divided into CR and NCR（ none CR） groups. The NCR group was subdivided into DCR（ dynamic CR） and CNCR（ continuous NCR） subgroups. Platelet aggregation rate（ PAR） was assessed at baseline and after 2 weeks treatment. PAR of NCR group was evaluated after 3 and 6 months posttreatment.Results LDL-C（ OR 3. 581,95% CI 2. 070 - 6. 195,P〈0. 0001） were clinical characteristics for P2Y12εC. Triglycerides（ OR 2.812,95%CI 1.498 -5.281,P =0.001） and glycosylated hemoglobin（ OR =2.327,95%CI 1.231 -4.398,P =0. 009） were clinical characteristics for CYP2C19εA. Incidences of CYP2C19εA and coexistence of P2Y12εC and CYP2C19εA in the CR and /or DCR groups were higher than in the NCR and /or CNCR groups（ P〈0. 05）. Conclusion LDL-C may be an clinical characteristic of the P2Y12 and Triglycerides（ TG） /glycosylated hemoglobin（ GHB） same to CYP2C19. It may be significant to the regulation of blood lipid metabolic and control DM disorder for preventing DCR.

关 键 词：脑梗死 氯吡格雷动态抵抗 基因突变 临床学特征 二级预防 

分 类 号：R743.3[医药卫生—神经病学与精神病学]