携带CYP2C19功能缺失等位基因的轻型卒中或高危短暂性脑缺血发作患者的双重抗血小板治疗  

Dual antiplatelet therapy in patients with minor stroke or high-risk transient ischemic attack carrying CYP2C19 loss-of-function alleles

作　　者：欧金鹏 刘毅[2] 马洁 Ou Jinpeng;Liu Yi;Ma Jie(The Fifth Clinical Medical College of Shanxi Medical University,Taiyuan 030000,China;Department of Neurology,Shanxi Provincial People's Hospital,Taiyuan 030000,China)

机构地区：[1]山西医科大学第五临床医学院,太原030000 [2]山西省人民医院神经内科,太原030000

出　　处：《国际脑血管病杂志》2023年第8期600-605,共6页International Journal of Cerebrovascular Diseases

摘　　要：双重抗血小板治疗已广泛用于轻型卒中及高危短暂性脑缺血发作(transient ischemic attack,TIA)患者的二级预防,目前通常采用的抗血小板药为阿司匹林和氯吡格雷。抗血小板药的治疗效果存在个体差异,即血小板抵抗。其中,阿司匹林抵抗多由药物依从性差所致,而氯吡格雷抵抗多与CYP2C19等位基因突变有关。携带CYP2C19功能缺失等位基因的轻度卒中及高危TIA患者使用氯吡格雷时预防效果欠佳,早期筛查CYP2C19功能缺失等位基因并采取针对性措施会为此类患者带来获益。文章针对携带CYP2C19功能缺失等位基因的轻型卒中或高危TIA患者的抗血小板治疗选择研究进展进行了综述。Dual antiplatelet therapy has been widely used for the secondary prevention in patients with minor stroke and high-risk transient ischemic attack(TIA).Currently,the commonly used antiplatelet drugs are aspirin and clopidogrel.The therapeutic effect of antiplatelet drugs varies among individuals,namely platelet resistance.Among them,aspirin resistance is often caused by poor drug compliance,while clopidogrel resistance is often associated with CYP2C19 allele mutations.Patients with minor stroke and high-risk TIA carrying CYP2C19 loss-of-function alleles have poor preventive effects when using clopidogrel.Early screening of the CYP2C19 loss-of-function alleles and targeted measures can benefit such patients.This article reviews the research progress on the selection of antiplatelet therapy for minor stroke or high-risk TIA patients carrying the CYP2C19 loss-of-function alleles.

关 键 词：卒中 脑缺血发作 短暂性 细胞色素P-450 CYP2C19 多态现象 遗传学 等位基因 抗血小板聚集药 氯吡格雷 

分 类 号：R743.3[医药卫生—神经病学与精神病学]