CYP2C19基因多态性对接受椎动脉支架患者预后的影响  

Effect of CYP2C19 Gene Polymorphism on Prognosis of Patients Receiving Vertebral Artery

作　　者：李元霄[1] 林汉斌[1] 刘昌云[1] 陈枝挺[1] LI Yuanxiao;LIN Hanbin;LIU Changyun;CHEN Zhiting(Department of Neurology,Fujian Medical University Union Hospital,Fuzhou 350001,China)

机构地区：[1]福建医科大学附属协和医院神经内科,福州350001

出　　处：《福建医科大学学报》2020年第1期18-22,共5页Journal of Fujian Medical University

摘　　要：目的探讨在椎动脉支架置入术后患者的CYP2C19基因型分布与椎动脉支架内再发狭窄、复发性卒中和出血等预后不良事件的关系。方法回顾性分析205例接受CYP2C19基因检测的椎动脉狭窄并行支架置入术患者的临床资料。根据CYP2C19基因型所致肝脏对药物代谢情况,将椎动脉支架置入术后患者分为快、中、慢代谢3组,观察预后。结果3组患者在接受氯吡格雷及阿司匹林双联抗血小板治疗前,血小板抑制率未达标(ADP%<50%)的患者数量比较,差别无统计学意义(P>0.05);接受氯吡格雷及阿司匹林双联抗血小板治疗6月后,差别有统计学意义(P<0.05)。3组患者在椎动脉支架置入术后规律氯吡格雷及阿司匹林双联抗血小板治疗6月内椎动脉支架内再狭窄和复发性脑梗死患者数量比较,差别有统计学意义(P<0.05),但对于其常见副作用如颅内出血及胃肠道、牙龈等其他部位出血的患者数量比较,差别无统计学意义(P>0.05)。结论在椎动脉支架置入术后患者中,CYP2C19基因快代谢型使用氯吡格雷及阿司匹林双联抗血小板治疗预防椎动脉支架内再狭窄、复发性脑梗死的获益明显优于中代谢型和慢代谢型,且颅内出血及胃肠道、牙龈等其他部位出血影响不明显。在椎动脉支架置入术后常规使用氯吡格雷及阿司匹林双联抗血小板治疗的患者中,CYP2C19基因多态性为影响患者椎动脉支架内再狭窄和复发性脑梗死的重要危险因素。Objective To investigate the relationship between the distribution of CYP2C19 genotype and adverse prognostic events such as restenosis,recurrent stroke and hemorrhage in patients with vertebral artery stenting.Methods The clinical data of 205 patients with vertebral artery stenosis and stent implantation were analyzed retrospectively.According to the liver metabolism caused by CYP2C19 genotype,patients after vertebral artery stent implantation were divided into three groups:fast metabolism in group A,moderate metabolism in group B,and slow metabolism in group C.The prognosis was observed.Results There was no significant difference in platelet inhibition rate(adenosine diphosphate inhibition rate,ADP%<50%)between the three groups before antiplatelet treatment with clopidogrel and aspirin(P>0.05).There was significant difference in platelet inhibition rate between the three groups after 6 months of antiplatelet treatment with clopidogrel and aspirin(P<0.05).During the 6 months of oral clopidogrel and aspirin dual antiplatelet therapy after vertebral artery stent implantation,there was a significant difference in the number of patients with recurrent cerebral infarction and restenosis of vertebral artery stent in the three groups(P<0.05).However,there was no statistical difference in the number of patients with common side effects such as intracranial hemorrhage and bleeding in other parts of the gastrointestinal tract and gingiva among the three groups(P>0.05).Conclusions In patients with vertebral artery stent implantation,clopidogrel and aspirin dual antiplatelet therapy,CYP2C19 gene fast metabolic type to prevent restenosis of vertebral artery stent,recurrent cerebral infarction benefits significantly better than the moderate metabolic type and slow metabolic type,but the effect of intracranial hemorrhage and bleeding in other parts of gastrointestinal tract and gingiva was not obvious in the patients.In the use of the dual anti-platelet therapy of chlordecay and aspirin after vertebral artery stenting,CYP2C19

关 键 词：椎底动脉供血不足 多态现象 遗传 多态性 限制性片段长度 血管疾病 支架 脑梗死 

分 类 号：R392.2[医药卫生—免疫学] R654.3[医药卫生—基础医学]