抗血小板聚集药物基因多态性及TEG检测在复发性大动脉粥样硬化梗死预防中的指导作用  

The guiding role of anti-platelet aggregation pharmacogene polymorphism and TEG detection in prevention of recurrent large atherosclerosis infarction

作　　者：王洋[1] 安文峰 于晓云 WANG Yang;AN Wen-feng;YU Xiao-yun(Department of Neurology,Xuchang Central Hospital Affiliated to Henan University of Science and Technology,Xuchang,Henan 461000,China)

机构地区：[1]河南科技大学附属许昌市中心医院神经内科,河南许昌461000

出　　处：《医药论坛杂志》2025年第3期318-322,327,共6页Journal of Medical Forum

摘　　要：目的探究抗血小板聚集药物基因多态性及血栓弹力图仪(thromboelastography,TEG)检测在复发性大动脉粥样硬化性脑梗死预防中的指导作用。方法将河南科技大学附属许昌市中心医院2022年11月至2023年11月期间纳入的80例复发性大动脉粥样硬化性脑梗死患者随机分为对照组(常规抗血小板治疗干预,n=40)和研究组(第1天检测抗血小板聚集药物基因多态性,第8天检测血小板抑制率,并给予抗血小板聚集药物基因多态性+TEG检测指导的个体化抗血小板治疗,n=40)。治疗后随访3个月,评估两组患者心脑血管疾病、脑出血疾病的发生情况。结果治疗第1天,基因检测(整合素B3、经环氧化酶1)发现研究组有20例(50.00%)患者携带阿司匹林抵抗相关等位基因,22例(55.00%)患者属于细胞色素P2C19氯吡格雷弱代谢型,11例(27.50%)患者携带氯吡格雷弱代谢型+阿司匹林抵抗相关基因。治疗第8天,TEG检测发现研究组3例(7.50%)患者属于阿司匹林抵抗,且均未携带整合素B3、经环氧化酶1的变异型等位基因;4例(10.00%)患者属于氯吡格雷抵抗;氯吡格雷抵抗+阿司匹林抵抗患者0例。随访3个月,试验组患者复合心脑血管疾病、新发脑卒中、新发大动脉粥样硬化性脑梗死的发生率(2.50%、0.00%、2.50%)低于对照组(20.00%、17.50%、22.50%),差异有统计学意义(P<0.05)。结论抗血小板聚集药物基因多态性及TEG检测指导治疗能够有效降低3个月内复发性大动脉粥样硬化性脑梗死发生的风险,且出血风险未明显增加。Objective To explore the guiding role of anti-platelet aggregation pharmacogene polymorphism and Thrombelastograph Analyzer(TEG)detection in the prevention of recurrent large atherosclastic cerebral infarction.Methods Eightypatients with recurrent large atherosclastic cerebral infarction enrolled in our hospital from November 2022 to November 2023 were randomly divided into control group(routine antiplatelet therapy intervention,n=40)and study group(anti-platelet aggregation drug gene polymorphism was detected on day 1,platelet inhibition rate was detected on day 8.Individual antiplatelet therapy guided by anti-platelet aggregation drug gene polymorphism and TEG detection was given,n=40).The patients were followed up for 3 months after treatment to evaluate the incidence of cardiovascular and cerebrovascular diseases and cerebral hemorrhage diseases in the two groups.Results On the first day of treatment,gene testing(integrin B3,transcyclooxygenase-1)found that 20 patients(50.00%)in the study group carried aspirin resistance related alleles,and 22 patients(55.00%)belonged to cytochrome P2C19 clopidogrel weak metabolites.Eleven patients(27.50%)carried clopidogrel weak metabolizer+aspirin resistance related genes.On the 8th day of treatment,TEG test showed that 3 patients(7.50%)in the study group were aspirin resistant,and none of them carried the variant alleles of integrin B3 and transcycoperoxidase 1.4 patients(10.00%)were clopidogrel resistant.There were 0 patients(0.00%)with clopidogrel resistance and aspirin resistance.After 3 months of follow-up,the incidence of complex vascular disease,new stroke and new large atherosclastic cerebral infarction in experimental group(2.50%,0.00%,2.50%)was lower than that in control group(20.00%,17.50%,22.50%,P<0.05).Conclusion Antiplatelet aggregation drug gene polymorphism and TEG detection guided treatment can effectively reduce the risk of recurrent large atherosclastic cerebral infarction within 3 months,and the risk of bleeding is not significantly increased.

关 键 词：抗血小板聚集药物 基因多态性 血栓弹力图仪检测 复发性大动脉粥样硬化性脑梗死 预防 

分 类 号：R543[医药卫生—心血管疾病]