摘要
目的探討CYP2C19基因多態性預期腦血管疾病支架置入團術期P2Y12受體抑制劑治療抗血小板功能關1像回顧與分析影響。方法回顧2016年9月~2017年5月中國澳門鏡湖醫院神經外科住院並接受P2Y12受體抑制劑(氯吡格雷)治療的48例腦血管疾病患者,包括腦動脈瘤、腦動脈狭窄(男性:19例;女性:29例;平均年齡63.9+26.38歲)。所有患者連續服用3~-5天阿司匹林和P2Y12受體抑制劑後第3、5、14天檢測Aspi rin+P2Y12測定治療功能,根據血小板反應單位(PRU)區分為高血小板反應組(HPR,PRU208)和非高血小板反應組(NPR,PRU<208)。同時利用即時多聚連接酶反應(Real-t imePCR)對患者CYP2C19*1、*2、*3和*17基因多態性進行檢測,根據基因檢測分為非基因功能缺失攜帶組和基因功能缺失攜帶組。利用單因素方差分析和多因素線性回歸來探討P2Y12受體抑制劑治療功能和基因多態性的關依。結果48例患者中包括未破裂腦動脈瘤19例,中度至重度腦動脈狹窄29例。CYP2C19*1等位基因42例(87.5%),CYP2C19*2等位基因6例(12.5%)。基因功能缺失攜帶組佔64.6%,攜帶-個功能缺失基因佔52.1%,攜帶兩個功能缺失基因佔12.5%。非基因功能缺失攜帶組的P2Y12抑制率高於基因功能缺失攜帶組(P<0.05)。結論攜帶CP2C19功能缺失等位基因的腦血管疾病患者,氯吡格雷藥效降低,臨床血管性事件風險增高。
Objective To investigate the e ect of CYP2C19 gene polymorphism on the anti-platelet function of P2Y12 receptor inhibitor treatment for patients with cerebrovascular disease and endovascular stent placement.Methods Forty-eight patients with cerebrovascular disease(cerebral aneurysms and cerebral arterial stenosis)treated with the P2Y12 receptor inhibitor Clopidogrel following endovascular stent placement were included.All patients were treated with aspirin and P2Y12 receptor inhibitors for 3 to 5 day.Blood samples were taken on the 3rd,5th,and 14th day for assessing the anti-platelet function. e(PRU)were divided into high platelet response group(HPR)wiht platelet response units(PRU) 208,and non-high platelet response(NHPR)with PRU<208.At the same time,the polymorphisms of CYP2C19*1,*2,*3 and*17 genes were detected by Real-time PCR.According to the genetic test,the patients were divided into non-genotype de cient group and genotype de cicent group. e relationship between the anti-platelet function and gene polymorphism of P2Y12 receptor inhibitor was investigated by one-way ANOVA and multivariate linear regression.Results ere were 19 cases of un-ruptured cerebral aneurysms and 29 cases of moderate to severe cerebral artery stenosis. ere were CYP2C19*1 allele in 42 cases(87.5%),and CYP2C19*2 allele in 6 cases(12.5%). e genotype-de cient carrying group accounted for 64.6%,with those carrying a functional deletion gene accounted for 52.1%and those carrying two functional deletion genes accounted for 12.5%. e inhibition rate of P2Y12 in non-genetically modi ed group was higher than that in genotype-de cient group(P<0.05).Conclusion In patients with cerebrovascular disease,the presence of CYP2C19 loss of function alleles casues decreased clopidogrel efficacy with raised clinical risk of vascular events.
作者
黃登輝
廖挺
WONG Tang Fai;LIAO Ting(Department of Neurosurgery,Kiang Wu Hospital,Macao,China)
出处
《镜湖医学》
2018年第1期13-17,共5页
MEDICAL JOURNAL OF KIANG WU
