CYP2C19基因多态性与血栓弹力图检测氯吡格雷药效相关性研究  

Study on the correlation between CYP2C19 gene polymorphism and the efficacy of clopyrrole in the detection of thromboelastography

作　　者：屠鸿翔[1] 叶银才 林超[1] 杨慧敏 TU Hong-xiang;YE Yin-cai;LIN Chao;YANG Hui-min(Clinical Laboratory,the First Affiliated Hospital of Wenzhou Medical University,Wenzhou,Zhejiang 325000,China)

机构地区：[1]温州医科大学附属第一医院检验科,浙江温州325000 [2]温州医科大学附属第一医院输血科,浙江温州325000

出　　处：《中国卫生检验杂志》2022年第4期436-438,共3页Chinese Journal of Health Laboratory Technology

基　　金：温州市科技局研究基金(Y20170811)

摘　　要：目的通过血栓弹力图(TEG)检测脑卒中患者血小板ADP抑制率并结合患者CYP2C19基因型检测结果,了解CYP2C19基因多态性对氯吡格雷药效的影响。方法选取912例诊断为脑卒中的患者,利用ARMS-PCR法测定CYP2C19基因型,并将6个基因型分为3组:Ⅰ组为正常基因纯合子组(*1/*1),Ⅱ组为正常基因与突变基因杂合子组(*1/*2,*1/*3),Ⅲ组为突变基因纯合子或杂合子组(*2/*2,*2/*3,*3/*3)。所有患者使用血栓弹力图测定血小板ADP抑制率。结果Ⅰ组359例(39.36%),Ⅱ组416例(45.61%),Ⅲ组137例(15.02%)。本地区氯吡格雷代谢类型以中快和快代谢为主,不同基因型性别比较差异无统计学意义(P>0.05)。3组ADP平均抑制率中位数分别为59.00%、54.90%、51.60%,三者之间差异无统计学意义(P>0.05)。结论CYP2C19基因多态性和血栓弹力图检查,早期识别氯吡格雷抵抗高危患者,还需要结合患者实际临床表现。Objective To detect the platelet inhibition rate of stroke patients through a thromboelastography(TEG)and to understand the effect of CYP2C19 gene polymorphism on the efficacy of clopidogrel in combination with the results of the patient’s CYP2C19 genotype.Methods A total of 912 patients diagnosed with stroke were selected,the CYP2C19 genotype was determined by ARMS-PCR method,and they were divided into three groups:group I was homozygous for normal genes(*1/*1),groupⅡwas normal genes heterozygous group with mutant gene(*1/*2,*1/*3),groupⅢis homozygous or heterozygous for mutant gene(*2/*2,*2/*3,*3/*3).All patients used thromboelastography to determine the platelet ADP inhibition rate.Results A total of 359 cases(39.36%)were selected in group I,416 cases(45.61%)in group II,and 137 cases(15.02%)in group III.Clopidogrel metabolism type in this area is mainly medium-fast and fast metabolism,there was no statistical significance on the difference in gender comparison among the three groups(P>0.05).The median average inhibition rates of ADP in the three groups were 59.00%,54.90%,and 51.60%,respectively,and there is no statistical significance on the difference in gender comparison of different genotypes(P>0.05).Conclusion The application of CYP2C19 gene polymorphism and thromboelastography examination to early identify patients at high risk of clopidogrel resistance needs to be combined with the actual clinical manifestations of the patients.

关 键 词：氯吡格雷 血栓弹力图 ADP抑制率 CYP2C19基因 基因多态性 

分 类 号：R541.4[医药卫生—心血管疾病]