CYP2C19基因多态性影响颈动脉血管内支架置入术后氯吡格雷疗效  

Association of CYP2C19 Polymorphisms with the Clinical Efficacy of Clopidogrel Therapy in Patients Undergoing Carotid Artery Stenting

作　　者：余建萍[1] 邹显巍[1] 张黎黎[1] 何仲春 马碧 YU Jian-ping;ZOU Xian-wei;ZHANG Li-li;HE Zhong-chun;Ma Bi(First Affiliated Hospital of Chengdu Medical College,Chengdu 610500,China)

机构地区：[1]成都医学院第一附属医院

出　　处：《微循环学杂志》2019年第3期53-56,共4页Chinese Journal of Microcirculation

摘　　要：目的:分析CYP2C19基因多态性对氯吡格雷治疗颈动脉血管内支架置入术(CAS)后患者氯吡格雷抵抗和支架内血栓形成的影响。方法:2014-10—2015-10在本院神经内科诊治的缺血性脑血管病需行CAS治疗的80例患者为研究对象。检测所有患者CYP2C19基因型,分析不同基因型患者所占比率,以及CYP2C19基因发生无功能突变(*2、*3)患者术后经氯吡格雷治疗3个月内氯吡格雷抵抗(CR)发生率和支架内血栓形成发生率的情况。结果:80例患者CYP2C19基因检测结果显示,*1/*2基因型所占比率最高,为37.50%,其次为*1/*1基因型(31.25%)。CYP2C19基因无功能突变(*2、*3)所占比率为68.75%,携带一个无功能突变基因(*1/*2、*1/*3)所占比率为45.00%,同时携带2个无功能突变基因(*2/*2、*2/*3、*3/*3)所占比率为23.75%。术后3个月后CR总发生率为25.00%,支架内血栓形成发生率为16.25%。CYP2C19*2基因携带者(*1/*2、*2/*2)CR发生率和支架内血栓形成发生率均高于CYP2C19*3基因携带者(*1/*3、*3/*3)(P<0.01)。结论:CYP2C19*2基因是影响CAS术后患者CR发生和支架内血栓形成的重要因素,影响患者预后。Objective:To analyze the value of CYP2C19 gene polymorphism in the regulation of antiplatelet therapy in paitents with carotid artery stenting.Method:80 patients with carotid artery stenting were enrolled in our hospital from October 2014 to October 2015.The incidence of patients with different CYP2C19 genotypes,platelet aggregation rate,clopidogrel resistanceand stent thrombosis were analyzed.Results:In the 80 cases of CYP2C19 gene screening,*1/*2 genotype accounted for the highest rate of 37.50%,followed by*1/*1 genotype was 31.25%.The percentage of nonfunctional mutations(*2,*3)in the CYP2C19 gene was 68.75%,and the ratio of nonfunctional mutant gene(*1/*2,*1/*3)was 45.00%.The percentage of non functional mutant genes(*2/*2,*2/*3,*3/*3)was 23.75%.The overall incidence of clopidogrel resistance was 25.00%and the incidence of thrombosis in the stent after 3 months surgery was 16.25%.The incidence of clopidogrel resistance and the incidence of stent thrombosis in CYP2C19*2(*1/*2,*2/*2)were statistically higher than in CYP2C19*3(*1/*3,*3/*3)(P<0.01).Conclusion:The CYP2C19*2 gene is an important factor in the occurrence of clopidogrel resistance and stent thrombosis in patients with carotid artery stenting,which affects the prognosis of patients.

关 键 词：CYP2C19基因 基因多态性 抗血小板治疗 氯比格雷抵抗 颈动脉狭窄支架置入术 

分 类 号：R654.4[医药卫生—外科学]