CYP2C19基因甲基化程度与血栓弹力图参数评价高血压脑出血患者应用止血剂的效果  

Correlation analysis of the CYP2C19 gene methylation and thromboelastographic parameters in patients with hypertensive intracerebral hemorrhage treated with hemostatic agents

作　　者：周兴悦 刘春莉 张厚亮 ZHOU Xingyue;LIU Chunli;ZHANG Houliang(Department of Immunology,Jinghai Hospital,Tianjin 301600,China)

机构地区：[1]天津市静海区医院免疫科,301600

出　　处：《河北医药》2024年第7期997-1001,共5页Hebei Medical Journal

摘　　要：目的探讨CYP2C19基因甲基化与高血压脑出血应用止血剂治疗患者血栓弹力图(TEG)参数相关性。方法患者根据CYP2C19基因分型分为A组快代谢型25例,B组中间代谢型32例,C组慢代谢型8例。采用西芬斯血栓弹力图仪进行TEG(R值、K值、Angle角、MA值、CI值)指标检测;采用亚硫酸氢盐测序PCR(BSP)方法检测CYP2C19基因启动子DNA甲基化水平。结果与治疗前比较,在临床个性化用药后,A组K值、CI值达到正常范围,α角增大约10°,MA值幅度增大17.73 mm,病情有明显的效果,出血情况得到控制。B组R值提升5.39 min,达到正常范围内,CI值增加1.62,B组用药后病情有所改善。C组指标变化不明显,所有TEG参数均未达到正常范围,说明C组在用药后的效果并不理想。CYP2C19基因启动子DNA甲基化水平和TEG参数相关分析,A组平均相关系数为0.21(P<0.05),B组平均相关系数为0.3(P<0.05),C组无相关性(P>0.05),这说明CYP2C19基因甲基水平与TEG参数有一定的相关性,尤其是对中间代谢型和快代谢型,但对于慢代谢型无相关性。结论CYP2C19基因甲基化程度及TEG参数对脑出血应用止血剂治疗患者凝血功能进行监测,可评价高血压脑出血患者应用止血剂效果。Objective To investigate the correlation between the CYP2C19 gene methylation and thromboelastographic(TEG)parameters in patients with hypertensive intracerebral hemorrhage treated with hemostatic agents.Methods Patients with hypertensive intracerebral hemorrhage were divided into group A(25 cases of fast metabolic type),group B(32 cases of intermediate metabolic type),and group C(8 cases of slow metabolic type)according to the CYP2C19 genotyping.TEG parameters,including the R value,K value,α-Angle,maximal amplitude(MA)and coagulation index(CI)were measured using the by the Xifensi thromboelastographic instrument(CFMS LEPU-Auto 8).The methylation level of CYP2C19 promoter was detected by bisulfite sequencing PCR(BSP).Results Compared with those before treatment,patients in group A presented the normal ranges of K value and CI,an increase in theα-Angle by 10°,an increase in the MA by 17.73mm,improved disease condition and controlled bleeding after individualized medication.Patients in group B presented an increase in the R value by 5.39 min(within the normal range),an increase in CI by 1.62 and improved disease condition.TEG parameters in group C were not significantly changed after treatment,and all of them did not recover into the normal ranges,suggesting the unsatisfactory efficacy.The correlation analysis of the DNA methylation level in the promoter region of the CYP2C19 gene and TEG parameters showed that the mean correlation coefficient in group A and B was 0.21(P<0.05),and 0.3(P<0.05),respectively,which was not correlated in group C(P>0.05).It is indicated that the methylation level of the CYP2C19 gene was correlated with TEG parameters,especially for the intermediate metabolic type and the fast metabolic type,but no correlation for the slow metabolic type.Conclusion The methylation level of the CYP2C19 gene and TEG parameters can be used to monitor the coagulation function of patients with hypertensive intracerebral hemorrhage treated with hemostatic agents,showing the predicting value in the efficacy o

关 键 词：血栓弹力图 高血压脑出血 止血剂 CYP2C19 甲基化 

分 类 号：R743.34[医药卫生—神经病学与精神病学]