血栓弹力图检测血小板抑制率与CYP2C19基因多态性在脑梗死复发患者中的临床意义  

Clinical significance of thromboelastography in detecting platelet inhibition rate and CYP2C19 gene polymorphism in patients with recurrent cerebral infarction

作　　者：王璐璐[1] 陈利达[1] 芦宏凯[1] 姜蕾[1] 赵儒 郑超[1] 刘希曦[1] 王琪[1] 王文静[1] 曹永彤[1] WANG Lulu;CHEN Lida;LU Hongkai;JIANG Lei;ZHAO Ru;ZHENG Chao;LIU Xixi;WANG Qi;WANG Wenjing;CAO Yongtong(Department of Blood Transfusion, China-Japan Hospital, Beijing 100029, China)

机构地区：[1]中日友好医院输血科

出　　处：《中国输血杂志》2019年第6期549-553,共5页Chinese Journal of Blood Transfusion

摘　　要：目的探讨血栓弹力图检测的血小板抑制率与CYP2C19基因多态性在脑梗死复发患者中的临床意义。方法收集中日友好医院2017年1月-12月神经内科入院的复发性脑梗死患者85例作为复发组,年龄51-61岁,男53例,女32例。并收集同期入院的未复发脑梗死患者41例作为未复发组,年龄52-61岁,男25例,女16例。通过血栓弹力图系统检测2组患者二磷酸腺苷诱导的血小板抑制率(ADP%)。从2组患者中随机选取95例,用ARMS-PCR方法进行CYP2C19基因多态性检测。计数资料采用χ~2检验,两独立样本计量资料采用独立样本t检验,以P<0.05为差异有统计学意义。进行多因素Logistic回归分析影响脑梗死复发的危险因素。结果脑梗死复发组氯吡格雷不敏感率为57.6%,未复发组氯吡格雷不敏感率为31.7%,复发组高于未复发组,差异有统计学意义(P<0.05)。复发组中,野生型CYP2C19~*1/~*1的基因型频率(19.7%)低于未复发组(58.9%),差异有统计学意义(P<0.05);而杂合突变型CYP2C19~*1/~*2的基因型频率(40.9%)高于未复发组(23.5%),差异有统计学意义(P<0.05);且纯合突变型CYP2C19~*2/~*2和CYP2C19~*3/~*3的基因频率(24.6%, 8.2%)高于未复发组(5.9%, 2.9%),差异有统计学意义(P均<0.05)。若按突变位点将CYP2C19基因多态性分成3组,则中间代谢型和弱代谢型的ADP%(55.61±0.744和15.69±1.196)均低于强代谢型(76.64±0.953),差异有统计学意义(P均<0.01);弱代谢型的ADP%(15.69±1.196)也低于中间代谢型(55.61±0.744),差异有统计学意义(P<0.05)。多元线性回归分析,CYP2C19基因型与ADP%密切相关(R^2=0.923,F=10.863,P<0.05。多因素Logistic回归分析,CYP2C19的基因多态性和高血压是脑梗死患者复发的独立危险因素,ADP%是脑梗死患者复发保护因素。结论长期服用氯吡格雷的脑梗死复发患者氯吡格雷不敏感率较高,且与CYP2C19基因多态性有密切关系。对于需长期服用氯吡格雷的脑梗死患者,关注其血小Objective To investigate the clinical significance of platelet inhibition rate and CYP2C19 gene polymorphism in patients with recurrent cerebral infarction. Methods 58 patients with recurrent cerebral infarction admitted to the Department of Neurology, China-Japanese Friendship Hospital from January to December 2017 were enrolled as recurrent group, including 53 males and 32 females,aged from51 to 61 years;while 41 patients with non-recurrent cerebral infarction admitted to the hospital in the same period were enrolled as non-recurrent group, including 25 males and 16 females, aged from 52 to 61 years. The platelet inhibition rate(ADP%) induced by adenosine diphosphate was measured by thromboelastography. The CYP2C19 gene polymorphism of 95 patients randomly selected from the two groups was detected by ARMS-PCR. The enumeration data is analyzed by the χ~2 test, and the measurement data from independent sample were analyzed by independent sample t test. The difference was statistically significant at P<0.05. Multivariate Logistic regression analysis was used to analyze risk factors of recurrent cerebral infarction.Results The rate of clopidogrel insensitivity was 57.6% in the recurrent cerebral infarction group and 31.7% in the non-recurrent group. The recurrent group was higher than the non-recurrent group,with statistically significant difference(P<0.05). The percentage of wild genotype CYP2C19~*1/~*1(19.7%) in the recurrent group was lower than that of the non-recurrent group(58.9%), and the difference was statistically significant(P<0.05). The percentage of the heterozygous mutant genotype CYP2C19~*1/~*2(40.9%)was higher than that of the non-recurrent group(23.5%), and the difference was statistically significant(P<0.05). The percentage of the homozygous mutant genotype CYP2C19~*2/~*2 and CYP2C19~*3/~*3(24.6%, 8.2%) was higher than that of the non-recurrent group(5.9%, 2.9%), and the difference was statistically significant(both P<0.05). If genetic polymorphism of CYP2C19 was divided into 3 groups according t

关 键 词：脑梗死 复发 CYP2C19基因多态性 血栓弹力图 血小板抑制率 

分 类 号：R743.3[医药卫生—神经病学与精神病学] R331.143[医药卫生—临床医学]