不同CYP2C19基因型脑梗死患者抗血小板策略及对预后的影响  

Antiplatelet Strategy and its Effect on Prognosis in Patients with Cerebral Infarction with Different CYP2C19 Genotypes

作　　者：张勇 钟群 丁娟 赖小莉 ZHANG Yong;ZHONG Qun;DING Juan;LAI Xiaoli(Department of Pharmacy,Yudu County People's Hospital,Yudu 342300,Jiangxi,China)

机构地区：[1]于都县人民医院药剂科,江西于都342300

出　　处：《医学信息》2024年第22期62-65,共4页Journal of Medical Information

基　　金：赣州市指导性科技计划项目(编号:GZ2023ZSF802)。

摘　　要：目的探讨不同CYP2C19基因型脑梗死患者以氯吡格雷抗血小板治疗的效果。方法选取于都县人民医院2021年10月-2023年6月收治的390例脑梗死患者作为研究对象。依据患者基因型不同分为快代谢型组(n=178)、中间代谢型组(n=155)和慢代谢型组(n=57),均予氯吡格雷治疗。比较三组患者血小板聚集率、NIHSS评分、ADL评分、血液流变学及血管内皮[血沉(ESR)、内皮素1(ET-1)、一氧化氮(NO)]指标水平。结果治疗后,快代谢型组血小板聚集率高于中间代谢型组、慢代谢型组(P<0.05);快代谢型组NIHSS评分低于中间代谢型组、慢代谢型组,ADL评分高于中间代谢型组、慢代谢型组(P<0.05);快代谢型组全血高切黏度、血浆黏度、ESR、ET-1水平均低于中间代谢型组及慢代谢型组,NO水平高于中间代谢型组及慢代谢型组(P<0.05)。结论CYP2C19不同基因型对脑梗死患者氯吡格雷的治疗效果有一定的影响,应该针对CYP2C19的不同基因型进行个体化治疗,以提高其治疗效果。Objective To investigate the effect of clopidogrel antiplatelet therapy in patients with cerebral infarction of different CYP2C19 genotypes.Methods A total of 390 patients with cerebral infarction admitted to Yudu County People's Hospital from October 2021 to June 2023 were selected as the study subjects.According to the different genotypes of patients,they were divided into fast metabolic group(n=178),intermediate metabolic group(n=155)and slow metabolic group(n=57).All patients were treated with clopidogrel.The platelet aggregation rate,NIHSS score,ADL score,hemorheology and vascular endothelium[erythrocyte sedimentation rate(ESR),endothelin 1(ET-1),nitric oxide(NO)]were compared among the three groups.Results After treatment,the platelet aggregation rate in the fast metabolic group was higher than that in the intermediate metabolic group and the slow metabolic group(P<0.05).The NIHSS score of the fast metabolic group was lower than that of the intermediate metabolic group and the slow metabolic group,and the ADL score was higher than that of the intermediate metabolic group and the slow metabolic group(P<0.05).The whole blood high shear viscosity,plasma viscosity,ESR and ET-1 levels in the fast metabolic group were lower than those in the intermediate metabolic group and the slow metabolic group,and the NO level was higher than that in the intermediate metabolic group and the slow metabolic group(P<0.05).Conclusion Different genotypes of CYP2C19 have a certain effect on the therapeutic effect of clopidogrel in patients with cerebral infarction.Therefore,clinicians should carry out individualized treatment for different genotypes of CYP2C19 to improve its therapeutic effect.

关 键 词：CYP2C19基因型 脑梗死 氯吡格雷 抗血小板 预后 

分 类 号：R743.33[医药卫生—神经病学与精神病学] R973.2[医药卫生—临床医学]