脑梗死患者血小板反应性与CYP2C19基因多态性的关系  

Relationship between platelet reactivity and gene polymorphism in patients with cerebral infarction

作　　者：王俊文[1] 于波 刘薇[1] 陆伟伟 徐飞[2] 任晓丹 高慧双 宋岩 WANG Junwen;YU Bo;LIU Wei;LU Weiwei;XU Fei;REN Xiaodan;GAO Huishuang;SONG Yan(Department of Clinical Laboratory,Chui Yang Liu Hospital,Beijing,China,100022;Graduate School of Hebei Medical University,Shijiazhuang,Hebei,China,50017)

机构地区：[1]北京市垂杨柳医院检验科,北京100022 [2]河北医科大学研究生院,河北石家庄050017

出　　处：《分子诊断与治疗杂志》2025年第1期163-166,共4页Journal of Molecular Diagnostics and Therapy

基　　金：北京市科技攻关计划(首发2021⁃1G⁃2032)。

摘　　要：目的探讨氯吡格雷给药后患者血小板反应性与患者CYP2C19基因型的关系。方法选取北京市垂杨柳医院神经内科2021年5月至7月患者60例,连续服用抗血小板药物3天后采用PL⁃12血小板功能分析仪检测患者服用氯吡格雷前后的血小板聚集率,计算其血小板抑制率;采用PCR⁃熔解曲线法检测患者的CYP2C19基因型(*1,*17,*2和*3),并将患者按照基因检测结果分为不同代谢类型。采用统计学方法分析CYP2C19不同代谢类型患者血小板抑制率的差异。结果60例患者共检测4种等位基因,8种基因型。根据CYP2C19基因多态性进行代谢分型,强代谢型(EM)26例,中间代谢型(IM)20例,弱代谢型(PM)14例。血小板聚集率在弱代谢型中较强代谢型高,差异有统计学意义(χ^(2)=0.174,P<0.05);弱代谢型与中间代谢型的血小板聚集率差异无统计学意义(χ^(2)=0.015,P>0.05);血小板聚集率在中间代谢型中较强代谢型高,差异无统计学意义(χ^(2)=0.983,P>0.05)。结论CYP2C19基因位点突变会导致患者出现对氯吡格雷的反应的差异性,影响患者使用氯吡格雷后血小板聚集率。Objective To investigate the relationship between platelet reactivity and CYP2C19 genotype in patients with cerebral infarction after clopidogrel administration.Methods 60 patients with cerebral infarction at the neurology department of Beijing Chui Yang Liu Hospital were selected to receive treatment with clopidogrel.The platelet aggregation rate was measured using PL⁃12 platelet function analyzer.The patientsCYP2C19 gene polymorphism(*1,*2,*3 and*17)was determined using the PCR⁃melting curve method,and they were divided into different metabolic types based on the genetic test results.The difference of platelet aggregation rate in patients with different metabolic types of CYP2C19 was analyzed using statistical methods.Results A total of 60 patients were tested for 4 alleles and 8 genotypes.According to the CYP2C19 gene polymorphism,there were 26 cases of strong metabolic type(EM),20 cases of intermediate metabolic type(IM),and 14 cases of poor metabolic type(PM).Platelet aggregation rate is higher in the stronger meta⁃bolic type among the weaker metabolic types,and the difference was statistically significant(χ^(2)=0.174,P<0.05).There was no statistically significant difference in platelet aggregation rate between poor metabolized and intermediate metabolized types(χ^(2)=0.015,P>0.05).Platelet aggregation rate was higher among intermedi⁃ate metabolic types compared to poor metabolic types,with no statistically significant difference(χ^(2)=0.983,P>0.05).Conclusion A mutation at the CYP2C19 gene site can cause variations in how patients respond to clopidogrel,impacting their platelet aggregation rate.Therefore,it is important to tailor antiplatelet therapy based on the patients CYP2C19 metabolic status to optimize the therapeutic outcome.

关 键 词：脑梗死 氯吡格雷 CYP2C19基因多态性 抗血小板 

分 类 号：R743.33[医药卫生—神经病学与精神病学]