[1]王利强,姚风芹,张俊河,等.豫北地区汉族急性脑梗死患者CYP2C19基因多态性与氯吡格雷抵抗的关系及发生氯吡格雷抵抗的危险因素分析[J].新乡医学院学报,2021,38(3):255-259.[doi:10.7683/xxyxyxb.2021.03.010]
　WANG Liqiang,YAO Fengqin,ZHANG Junhe,et al.Analysis of the relationship between CYP2C19 gene polymorphism and clopidogrel resistance and risk factors of clopidogrel resistance of patients with acute cerebral infarction of Han nationality in northern Henan[J].Journal of Xinxiang Medical University,2021,38(3):255-259.[doi:10.7683/xxyxyxb.2021.03.010]
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豫北地区汉族急性脑梗死患者CYP2C19基因多态性与氯吡格雷抵抗的关系及发生氯吡格雷抵抗的危险因素分析
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《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:
38
期数:
2021年3
页码:
255-259
栏目:
临床研究
出版日期:
2021-03-05

文章信息/Info

Title:
Analysis of the relationship between CYP2C19 gene polymorphism and clopidogrel resistance and risk factors of clopidogrel resistance of patients with acute cerebral infarction of Han nationality in northern Henan
作者:
王利强1; 姚风芹2; 张俊河3; 崔月龙4; 周绍娟5; 陈瑞锋6; 胡蓉蓉7; 刘文君1
（1.濮阳市安阳地区医院精准医学实验室，河南　安阳　455000；2.濮阳市安阳地区医院病案管理科，河南　安阳　455000；3.新乡医学院生物化学与分子生物学教研室，河南　新乡　453003；4.濮阳市安阳地区医院放疗科，河南　安阳　455000；5.濮阳市安阳地区医院体检中心，河南　安阳　455000；6.濮阳市安阳地区医院心内科,河南　安阳　455000；7.濮阳市安阳地区医院神经康复科，河南　安阳　455000 ）
Author(s):
WANG Liqiang1; YAO Fengqin2; ZHANG Junhe3; CUI Yuelong4; ZHOU Shaojuan5; CHEN Ruifeng6; HU Rongrong7; LIU Wenjun1
1.Laboratory of Precision Medicine,Anyang District Hospital of Puyang City2.Department of Medical Records Management,Anyang District Hospital of Puyang City3.Department of Molecular Biology,Xinxiang Medical University4.Radiotherapy Department,Anyang District Hospital of Puyang City5.Physical Examination Center,Anyang District Hospital of Puyang City6.Department of Cardiology,Anyang District Hospital of Puyang City7.Department of Neurore Habilitation,Anyang District Hospital of Puyang City
关键词:
CYP2C19基因多态性; 氯吡格雷抵抗; 脑梗死; 血栓弹力图
Keywords:
CYP2C19 gene polymorphismclopidogrel resistancecerebral infarctionthromboelastogram
分类号:
R969
DOI:
10.7683/xxyxyxb.2021.03.010
文献标志码:
A
摘要:
目的　探讨豫北地区汉族急性脑梗死患者CYP2C19基因多态性与氯吡格雷抵抗的关系及发生氯吡格雷抵抗的危险因素。方法　选择濮阳市安阳地区医院2018年6月至2019年12月收治的210例急性脑梗死患者为研究对象，所有急性脑梗死患者于急性期用尿激酶溶栓治疗24 h后，给予氯吡格雷常规治疗6 d,治疗后抽取患者清晨空腹静脉血。采用荧光原位杂交技术检测患者CYP2C19基因型；采用血栓弹力图检测患者静脉血中二磷酸腺苷（ADP）诱导血小板聚集抑制率和血栓形成的最大振幅（MA）值；采用多元logistic回归分析发生氯吡格雷抵抗的危险因素。结果　CYP2C19基因快代谢型、中间代谢型和慢代谢型脑梗死患者分别有94、65、51例。CYP2C19基因中间代谢型和慢代谢型脑梗死患者的ADP诱导血小板聚集抑制率显著低于快代谢型（P<0.05）；cyp2c19基因慢代谢型脑梗死患者的adp聚集抑制率显著低于中间代谢型（>P<0.05）。cyp2c19基因中间代谢型和慢代谢型脑梗死患者的ma值显著高于快代谢型（>P<0.05）；cyp2c19基因慢代谢型脑梗死患者的ma值显著高于中间代谢型（>P2=4.639、19.136，P<0.05）；CYP2C19基因慢代谢型脑梗死患者的氯吡咯雷抵抗发生率显著高于中间代谢型（χ2=5.107，P<0.05）。多元logistic回归分析显示，ADP诱导血小板聚集抑制率和血栓弹力图MA值是CYP2C19基因中间代谢型、慢代谢型脑梗死患者发生氯吡格雷抵抗的独立危险因素（P<0.05）。>结论　豫北地区汉族急性脑梗死患者CYP2C19基因中间代谢型和慢代谢型发生氯吡格雷抵抗率较高，ADP诱导血小板聚集抑制率和血栓弹力图MA值是中间代谢型和慢代谢型急性脑梗死患者发生氯吡格雷抵抗的独立危险因素。undefinedundefinedundefinedundefined
Abstract:
Objective　To investigate the relationship between CYP2C19 gene polymorphism and clopidogrel resistance of patients with acute cerebral infarction of Han nationality in northern Henan,and to analyze the risk factors of clopidogrel resistance.Methods　A total of 210 patients with acute cerebral infarction who were admitted to Anyang District Hospital of Puyang City from June 2018 to December 2019 were selected as the research objects.All patients with acute cerebral infarction were treated with urokinase thrombolytic therapy for 24 hours in the acute phase,and after routine treatment with clopidogrel for 6 days,fasting venous blood was drawn from the patients early in the morning.The CYP2C19 genotype in patients was detected by fluorescence in situ hybridization;the inhibition rate of platelet aggregation induced by adenosine diphosphate (ADP) and the maximum amplitude(MA)　of thrombus formation were detected by thromboelastography;the risk factors of clopidogrel resistance was analyzed by multivariate logistic regression.Results　There were 94,65 and 51 cerebral infarction patients with fast metabolizing,intermediate metabolizing and slow metabolizing CYP2C19 gene,respectively.The inhibitory rate of platelet aggregation induced by ADP of cerebral infarction patients with intermediate metabolizing and slow metabolizing CYP2C19 gene was significantly lower than that with fast metabolizing type (P<0.05);the inhibitory rate of platelet aggregation induced by ADP of cerebral infarction patients with slow metabolizing CYP2C19 gene was significantly lower than that with intermediate metabolizing type (P<0.05).The MA value of cerebral infarction patients with intermediate metabolizing and slow metabolizing CYP2C19 gene was significantly higher than that with fast metabolizing type (P<0.05);the MA value of cerebral infarction patients with slow metabolizing CYP2C19 gene was significantly higher than that with intermediate metabolizing type (P<0.05).The incidence of clopidogrel resistance in cerebral infarction patients with fast metabolizing,intermediate metabolizing and slow metabolizing CYP2C19 gene was 30.85% (29/94),47.69% (31/65) and 68.63% (35/51),respectively.The incidence of clopidogrel resistance of cerebral infarction patients with intermediate metabolizing and slow metabolizing CYP2C19 gene was significantly higher than that with fast metabolizing type (χ2=4.639,19.136;P<0.05);the incidence of clopidogrel resistance of acute cerebral infarction patients with slow metabolizing CYP2C19 gene was significantly higher than that with intermediate metabolizing type (χ2=5.107,P<0.05).Multivariate logistic regression analysis showed that inhibition rate of platelet aggregation induced by ADP and MA value of thromboelastogram were independent risk factors for clopidogrel resistance of cerebral infarction patients with intermediate metabolizing and slow metabolizing CYP2C19 gene（P<0.05）.Conclusion　The acute cerebral infarction patients with intermediate metabolizing and slow metabolizing CYP2C19 gene of Han nationality in northern Henan have a higher clopidogrel resistance rate,and the inhibition rate of platelet aggregation induced by ADP and MA value of thromboelastogram are the independent risk factors for clopidogrel resistance of cerebral infarction patients with intermediate metabolizing and slow metabolizing CYP2C19 gene.

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更新日期/Last Update: 2021-03-05