CYP2C19基因多态性联合生化指标预测脑梗死患者氯吡格雷抵抗的价值分析  

Value of CYP2C19 gene polymorphism combined with biochemical indicators in predicting clopidogrel resistance in patients with cerebral infarction

作　　者：陈柯霖[1] 刘嘉融 刘紫薇 王玉飞 李斯文 周金[1] 刘淑静[1] 张国军[1] CHEN Kelin;LIU Jiarong;LIU Ziwei;WANG Yufei;LI Siwen;ZHOU Jin;LIU Shujing;ZHANG Guojun(Department of Clinical Laboratory,Beijing Tiantan Hospital,Capital Medical University/Beijing Engineering Research Center of Immunological Reagents Clinical Research/NMPA Key Laboratory for Quality Control of In Vitro Diagnostics,Beijing 100070,China;Clinical Diagnosis College,Capital Medical University,Beijing 100070,China)

机构地区：[1]首都医科大学附属北京天坛医院检验科/北京市免疫试剂临床工程技术研究中心/国家药品监督管理局体外诊断试剂质量控制重点实验室,北京100070 [2]首都医科大学临床检验诊断学系,北京100070

出　　处：《国际检验医学杂志》2024年第23期2829-2833,共5页International Journal of Laboratory Medicine

基　　金：北京市高层次公共卫生技术人才建设项目培养计划(2022-2-013)。

摘　　要：目的探究CYP2C19基因多态性和生化指标联合预测脑梗死患者氯吡格雷抵抗(CR)的价值。方法选取首都医科大学附属北京天坛医院2021年1月至2023年12月收治的387例脑梗死患者作为研究对象,根据患者入院后血小板聚集试验-二磷酸腺苷(PAgT-ADP)的检测结果将脑梗死患者分为氯吡格雷有效组(PAgT-ADP≤43%)和CR组(PAgT-ADP>43%)。观察脑梗死患者CYP2C19基因分型的分布情况,并回顾性分析两组患者的年龄、性别和生化指标[包括尿素、肌酐(Cr)、尿酸(UA)、丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、总胆红素(TBIL)、直接胆红素(DBIL)、间接胆红素(IBIL)、乳酸脱氢酶(LDH)、三酰甘油(TG)、总胆固醇(CHO)、高密度脂蛋白胆固醇(HDL)、低密度脂蛋白胆固醇(LDL)、同型半胱氨酸(Hcy)]。对统计指标进行单因素分析,通过多因素Logistic回归分析构建联合预测模型,绘制受试者工作特征(ROC)曲线分析CYP2C19基因代谢类型单独及联合生化指标对预测脑梗死患者CR的效能。结果CR组和氯吡格雷有效组性别、Cr、TBIL、DBIL、IBIL、Hcy及CYP2C19基因代谢类型比较差异均有统计学意义(P<0.05);多因素Logistic回归分析结果显示,Cr、ALT、AST、TBIL、DBIL、IBIL、CHO、LDL、CYP2C19基因代谢类型为脑梗死患者CR的独立预测因子(P<0.05);ROC曲线分析结果显示,联合预测模型预测脑梗死患者CR的曲线下面积为0.720,灵敏度和特异度分别为71.1%和65.5%,而CYP2C19基因代谢类型单独预测脑梗死患者CR的曲线下面积为0.641,灵敏度和特异度分别为67.3%和56.9%,联合预测模型的曲线下面积与CYP2C19基因代谢类型的曲线下面积比较差异有统计学意义(P<0.05)。结论CYP2C19基因多态性联合生化指标有助于预测脑梗死患者CR的发生,尤其对于CR而CYP2C19基因代谢型表现为正常代谢的患者有较好的预测价值。Objective To study the value of CYP2C19 gene polymorphism combined with biochemical indicators in predicting clopidogrel resistance(CR)in patients with cerebral infarction.Methods A total of 387 patients with cerebral infarction admitted to Beijing Tiantan Hospital,Capital Medical University from January 2021 to December 2023 were selected as the research subjects.According to the test results of platelet aggregation test-adenosine diphosphate(PAgT-ADP)after admission,the patients with cerebral infarction were divided into clopidogrel effective group(PAgT-ADP≤43%)and CR group(PAgT-ADP>43%).The distribution of CYP2C19 genotype in patients with cerebral infarction were observed.The age,gender and biochemical indicators,including urea,creatinine(Cr),uric acid(UA),alanine aminotransferase(ALT),aspartate aminotransferase(AST),total bilirubin(TBIL),direct bilirubin(DBIL),indirect bilirubin(IBIL),lactate dehydrogenase(LDH),triglycerides(TG),total cholesterol(CHO),high-density lipoprotein cholesterol(HDL),low-density lipoprotein cholesterol(LDL),homocysteine(Hcy),of the two groups were retrospectively analyzed.Single factor analysis was conducted on statistical indicators,and a combined prediction model was constructed through multivariate Logistic regression analysis.Receiver operating characteristic(ROC)curve was plotted to analyze the efficacy of CYP2C19 gene metabolic types alone and in combination with biochemical indicators for predicting CR in patients with cerebral infarction.Results The gender,Cr,TBIL,DBIL,IBIL,Hcy and CYP2C19 gene metabolic types showed statistically significant differences between the CR group and the clopidogrel effective group(P<0.05).Multivariate Logistic regression analysis showed that Cr,ALT,AST,TBIL,DBIL,IBIL,CHO,LDL and CYP2C19 gene metabolic types were independent predictors of CR(P<0.05).ROC curve analysis results showed that the area under the curve of the combined prediction model for predicting CR in patients with cerebral infarction was 0.720,and the sensitivity and the specific

关 键 词：CYP2C19基因多态性 氯吡格雷抵抗 脑梗死 生化指标 

分 类 号：R446.1[医药卫生—诊断学]