CYP2C19基因多态性与急性脑梗死患者氯吡格雷抵抗的关系  

Relationship of CYP2C19 polymorphism and clopidogrel resistance in patients with acute cerebral infarction

作　　者：江秀龙[1,2] 张旭[1,2] 陈兴泳[1,2] 雷惠新[1,2] 

机构地区：[1]福建医科大学省立临床学院 [2]福建省立医院神经内科,350001

出　　处：《临床神经病学杂志》2015年第4期255-258,共4页Journal of Clinical Neurology

基　　金：福建省自然科学基金(2013J01275)

摘　　要：目的 探讨CYP2C19基因多态性与急性脑梗死患者氯吡格雷抵抗的关系。方法 检测118例急性脑梗死患者的CYP2C19基因,根据基因型分为野生型组、突变杂合型组及突变纯合型组。使用血栓弹力图测定二磷酸腺苷（ADP）诱导的血小板聚集抑制率,比较各组结果。结果 根据基因分型,将患者分为野生型组45例（38.1%）,突变杂合型组54例（45.8%）及突变纯合型组19例（16.1%）。与野生型组比较,突变纯合型组与突变杂合型组的血小板抑制率均显著下降（均P〈0.01）,氯吡格雷抵抗率明显增高（P〈0.05~0.01）。与突变杂合型组比较,突变纯合型组的血小板抑制率显著下降（P〈0.01）,氯吡格雷抵抗率差异无统计学意义。Logistic多元回归分析显示,携带CYP2C19突变杂合型等位基因及突变纯合型等位基因与血小板抑制率呈正相关,是氯吡格雷抵抗的独立危险因素（OR=2.13,95%CI：1.78~4.28,P=0.013;OR=4.44,95%CI：3.31~6.41,P=0.001）。结论 CYP2C19突变型等位基因是氯吡格雷低应答的独立危险因素。Objective To explore the relationship of CYP2C19 polymorphism and clopidogrel resistance in patients with acute cerebral infarction. Methods The CYP2C19 gene was detected in 118 cases with acute cerebral infarction. According to genotype, patients were divided into wild type group, mutation heterozygous genotype group and mutation homozygous genotype group. Platelet inhibitory rates of adenosine diphosphate （ADP） receptors were evaluated by thromboelastography, the results were compared among the three groups. Results According to genotype, patients were divided into wild type group 45 cases （38.1% ）, mutation heterozygous genotype group 54 cases （45.8%） and mutation homozygous genotype group 19 cases （16.1%）. Compared with wild type group, the platelet inhibitory rates in mutation homozygous genotype group and mutation heterozygous genotype group were significantly decreased （ all P 〈 0. 01 ） , and the rate of Clopidrogel resistance were significantly increased （ P 〈 0. 05 - 0. 01 ）. Compared with mutation heterozygous genotype group, the platelet inhibitory rates in mutation homozygous genotype group were significantly decreased （ P 〈 0. 01 ）, and there was no statistical significance between the two groups. Logistic multiple regression analysis showed the mutation homozygous genotype and mutation heterozygous genotype of CYP2C19 were positively correlated with platelet inhibitory rate, they were independent risk factors for clopidrogel resistance （OR =2. 13, 95% CI： 1.78 - 4.28, P = 0. 013; OR = 4.44, 95% CI： 3.31 - 6.41, P = 0. 001 ）. Conclusion The mutant alleles of CYP2C19 is independent risk factor for clopidrogel resistance.

关 键 词：氯吡格雷抵抗 CYP2C19 基因多态性 血小板抑制率 

分 类 号：R743.3[医药卫生—神经病学与精神病学]