调整的抗血小板聚集治疗方案对老年未破裂颅内动脉瘤介入治疗围手术期缺血事件发生的影响分析  

Influence of adjusted antiplatelet aggregation regimen on perioperative ischemic events after interventional treatment of unruptured intracranial aneurysms in elderly patients

作　　者：顾大群 汪洋[1] 张扬[1] 晁迎九 高歌 陈昱[1] 余舰 Gu Daqun;Wang Yang;Zhang Yang;Chao Yingjiu;Gao Ge;Chen Yu;Yu Jian(Department of Neurosurgery,the First Affiliated Hospital of University of Science and Technology of China,Hefei 230001,China)

机构地区：[1]中国科学技术大学附属第一医院神经外科,合肥230001

出　　处：《中国脑血管病杂志》2023年第1期20-26,F0003,共8页Chinese Journal of Cerebrovascular Diseases

摘　　要：目的 探索应用细胞色素P450 2C19(CYP2C19)基因检测调整抗血小板聚集治疗方案对老年未破裂颅内动脉瘤支架辅助弹簧圈栓塞围手术期缺血事件的影响。方法 回顾性连续纳入2018年1月至2021年12月中国科学技术大学附属第一医院神经外科行介入治疗的老年(年龄≥60岁)未破裂颅内动脉瘤住院患者343例,依据中国科学技术大学附属第一医院开始开展CYP2C19基因检测技术的时间(2021年1月),将343例老年未破裂颅内动脉瘤患者分为非基因检测组(2018年1月至2020年12月)和基因检测组(2021年1—12月)。非基因检测组采用常规抗血小板聚集治疗方案(阿司匹林100 mg/次和氯吡格雷75 mg/次,1次/d),基因检测组根据CYP2C19基因检测结果调整抗血小板聚集治疗方案(对于超快代谢型及快代谢型患者,给予阿司匹林肠溶片100 mg/次和氯吡格雷75 mg/次,1次/d;对于中间代谢型及慢代谢型患者,给予阿司匹林肠溶片100 mg/次1次/d和替格瑞洛90 mg/次2次/d),比较两组术中及术后1个月内发生缺血事件的差异,同时对影响缺血事件的相关因素进行单因素分析和多因素Logistic回归分析。结果 343例老年未破裂颅内动脉瘤患者中,非基因检测组181例,基因检测组162例。(1)非基因检测组与基因检测组患者性别、年龄、高血压病、糖尿病、高脂血症、吸烟史、颅内动脉粥样硬化、动脉瘤大小、动脉瘤部位、支架类型、动脉瘤栓塞程度、出血事件的差异均无统计学意义(均P>0.05);基因检测组缺血事件发生率低于非基因检测组,组间差异有统计学意义[4.9%(8/162)比11.6%(21/181),χ^(2)=4.905,P=0.027]。(2)发生缺血事件组与未发生缺血事件组患者性别、年龄、高血压病、糖尿病、高脂血症、动脉瘤大小、动脉瘤部位、动脉瘤栓塞程度的差异均无统计学意义(均P>0.05);未发生缺血事件组患者吸烟、颅内动脉粥样硬化、使用编织型支架比例Objective To explore the significance of adjusting antiplatelet aggregation regimen based on cytochrome P450 2C19(CYP2C19) gene detection in the prevention of perioperative ischemic events in elderly with unruptured intracranial aneurysms by stent-assisted coil embolization. Methods A total of 343 elderly inpatients(aged ≥60 years) with unruptured intracranial aneurysm who underwent interventional treatment in the Department of Neurosurgery of the First Affiliated Hospital of University of Science and Technology of China from January 2018 to December 2021 were retrospectively included. According to the timing of CYP2C19 gene testing in the First Affiliated Hospital of University of Science and Technology of China(January 2021), 343 elderly patients with unruptured intracranial aneurysms were divided into non-genetic testing group(January 2018 to December 2020) and genetic testing group(January 2021 to December 2021). The non-genetic testing group was treated with conventional anti-platelet aggregation therapy(Aspirin 100 mg/time and clopidogrel 75 mg/time, once/d). While the genetic testing group adjusted anti-platelet aggregation therapy according to the results of CYP2C19 gene testing(for patients with ultra-fast metabolism and fast metabolism, Aspirin enteric-coated tablets 100 mg/time and clopidogrel 75 mg/time, once/d were given;for intermediate and slow metabolites, Aspirin enteric-coated tablets 100 mg/time, once/d and ticagrelor 90 mg/time, twice/d were given) were carried out to compare the intraoperative and postoperative differences in ischemic events between the two groups, and univariate and multivariate analysis of the related factors affecting ischemic events was conducted. Results Among 343 elderly patients with unruptured intracranial aneurysm, 181 cases were in the non-genetic testing group and 162 cases in the genetic testing group.(1) There were no significant differences in sex, age, history of hypertension, diabetes, smoking history, hyperlipidemia, intracranial atherosclerosis, aneurysm s

关 键 词：基因检测 细胞色素P450酶系统 双重抗血小板治疗 颅内动脉瘤 介入治疗 缺血事件 

分 类 号：R743[医药卫生—神经病学与精神病学]