氯吡格雷精准用药对轻型缺血性脑卒中与短暂性脑缺血发作患者预后的影响  

Analysis the effect of precision medication of clopidogrel on prognosis of patients with minor ischemic stroke and transient ischemic attack

作　　者：农媛[1] 杨智文 杨吉 秦柱贵 黄日玲 NONG Yuan;YANG Zhi-wen;YANG Ji(Department of Neurology,Guigang People's Hospital,Guigang 537100,China)

机构地区：[1]贵港市人民医院神经内科,537100 [2]贵港市人民医院临床药学科,537100 [3]贵港市人民医院脑血管病中心,537100

出　　处：《中国实用医药》2023年第8期1-7,共7页China Practical Medicine

基　　金：贵港市科学研究与技术开发计划项目(项目编号:贵科计2117018)。

摘　　要：目的分析氯吡格雷精准用药指导对轻型缺血性脑卒中(MIS)与短暂性脑缺血发作(TIA)患者预后的影响。方法回顾性分析305例MIS与TIA患者的临床资料,根据是否进行CYP2C19基因多态性检测指导氯吡格雷抗血小板治疗分为研究组(是,138例)和对照组(否,167例)。研究组患者根据CYP2C19基因检测结果个体化使用氯吡格雷联合阿司匹林双抗3周,后改氯吡格雷个体化单抗治疗;对照组患者按指南常规给予氯吡格雷+阿司匹林双抗治疗3周,后改氯吡格雷常规单抗治疗。采用倾向性评分匹配(PSM)方法控制两组间的混杂因素,比较两组PSM前后的一般资料,PSM后治疗安全性及有效性,并采用二元Logistic回归分析缺血性脑卒中(IS)复发的影响因素。结果研究组中以CYP2C19正常代谢型占比最高,为41.30%(57/138),其次为中间代谢型40.58%(56/138),慢代谢型15.22%(21/138),快代谢型占比最低,为2.90%(4/138)。PSM前,研究组大血管狭窄率28.99%(40/138)及女性占比19.57%(27/138)低于对照组的43.11%(72/167)、33.53%(56/167),差异具有统计学意义(P<0.05)。PSM前,两组年龄、糖尿病病史、高血压病史、脑卒中病史、吸烟史、饮酒史、体质量指数(BMI)、入院美国国立卫生研究院卒中量表(NIHSS)评分、入院低密度脂蛋白胆固醇(LDL-C)比较差异无统计学意义(P>0.05)。PSM后,研究组115例,对照组115例。两组性别、年龄、糖尿病病史、高血压病史、脑卒中病史、吸烟史、饮酒史、BMI、入院NIHSS评分、入院LDL-C、大血管狭窄率比较差异均无统计学意义(P>0.05)。研究组6个月时IS复发率6.96%显著低于对照组的15.65%,差异具有统计学意义(P<0.05);两组总出血事件发生率、中重度出血发生率以及6个月时功能结局良好率比较差异无统计学意义(P>0.05)。230例患者中,IS复发26例,未复发204例。单因素分析显示:IS复发患者氯吡格雷个体化治疗占比为30.77%(8/26),低于未复发�Objective To analyze the effect of precision medication of clopidogrel on prognosis of patients with minor ischemic stroke(MIS)and transient ischemic attack(TIA).Methods Clinical data of 305 patients with MIS and TIA were retrospectively analyzed and divided into research group(yes,138 cases)and control group(no,167 cases)according to whether CYP2C19 gene polymorphism was detected to guide clopidogrel antiplatelet therapy.Patients in the research group were individually treated with clopidogrel combined with aspirin for 3 weeks according to CYP2C19 gene test results,and then changed to clopidogrel individual mab treatment.Patients in the control group were routinely given clopidogrel combined with aspirin for 3 weeks according to the guidelines,and then changed to clopidogrel conventional monotherapy.The tendency score matching(PSM)method was used to control the confounding factors between the two groups,and the general clinical data before and after PSM between the two groups were compared,as well as the safety and effectiveness treatment between the two groups after PSM.Binary Logistic regression was used to analyze the influencing factors of recurrence of ischemic stroke(IS).Results In the study group,the proportion of normal metabolic type in CYP2C19 was the highest,as 41.30%(57/138),followed by intermediate metabolizer 40.58%(56/138),poor metabolizer 15.22%(21/138)and rapid metabolizer was the lowest,as 2.90%(4/138).Before PSM,the rates of great vessel stenosis in the research group was 28.99%(40/138)and the proportion of females was 19.57%(27/138),which were lower than those of 43.11%(72/167)and 33.53%(56/167)in the control group,and the differences were statistically significant(P<0.05).Before PSM,the differences in age,history of diabetes mellitus,history of hypertension,history of stroke,history of smoking,history of alcohol consumption,body mass index(BMI),admission National Institutes of Health Stroke Scale(NIHSS)score,and admission low-density lipoprotein cholesterol(LDL-C)between the two groups were

关 键 词：氯吡格雷 精准用药 轻型缺血性脑卒中 短暂性脑缺血发作 预后 

分 类 号：R743.3[医药卫生—神经病学与精神病学]