药物基因多态性检测在脑梗死患者抗血小板治疗中的应用

The roles of drug-related genetic polymorphisms in antiplatelet therapy in cerebral infarction patients

摘要:

目的 探究药物基因多态性检测在脑梗死患者抗血小板治疗中的应用前景。方法 选取2019年1月—2020年3月在东莞东华医院就诊的脑梗死患者298例，所有患者发病24 h内给予氯吡格雷联合阿司匹林治疗，收集患者基本信息并检测CYP2C19、PTGS1、GP1BA基因。治疗14 d后，应用改良Rankin量表（mRS）评估患者预后情况，并分为预后良好组和预后不良组。结果 脑梗死患者中快代谢型156例（52.35%），中间代谢型86例（28.86%），慢代谢型56例（18.79%），同时阿司匹林敏感型290例（97.32%），阿司匹林半敏感型5例（1.68%），阿司匹林抵抗型3例（1.00%）。预后良好组中快代谢型140例（59.07%），中间代谢型67例（28.27%），慢代谢型30例（12.66%）。预后不良组中快代谢型16例（26.23%），中间代谢型19例（31.15%），慢代谢型26例（42.62%），两组比较差异有统计学意义（P <0.05）。预后良好组中阿司匹林敏感型234例（98.74%），阿司匹林半敏感型2例（0.84%）和阿司匹林抵抗型1例（0.42%）。预后不良组中阿司匹林敏感型56例（91.80%），阿司匹林半敏感型3例（4.92%），阿司匹林抵抗型2例（3.28%），两组比较差异有统计学意义（P <0.05）。结论 CYP2C19、PTGS1、GP1BA基因多态性对脑梗死患者氯吡格雷联合阿司匹林抗血小板治疗预后有影响。检测CYP2C19、PTGS1、GP1BA基因多态性对预测脑梗死患者治疗预后具有指导意义。

Abstract:

Objective To explore the application prospect of drug-related genetic polymorphisms in antiplatelet therapy in cerebral infarction patients.Methods The 298 cerebral infarction patients treated in our hospital from January 2019 to March 2020 were selected. All patients were given clopidogrel and aspirin within 24 hours after disease onset. The basic information of the patients was collected, and cytochrome P450 2C19 (CYP2C19), prostaglandin-endoperoxide synthase 1 (PTGS1) and glycoprotein Ib α polypeptide (GP1BA) gene polymorphisms were detected. After 14 days of treatment, the patients were divided into the good prognosis group and the poor prognosis group by Modified Rankin Scale (mRS) score.Results Among the cerebral infarction patients, there were 156 extensive metabolizers (52.35%), 86 intermediate metabolizers (28.86%) and 56 poor metabolizers (18.79%) for clopidogrel. Besides, 290 of them were aspirin-sensitive (97.32%), 5 of them were semi-responders (1.68%) and 3 of them were aspirin-resistant (1.00%). In the good prognosis group, there were 140 extensive metabolizers (59.07%), 67 intermediate metabolizers (28.27%) and 30 poor metabolizers (12.66%) for clopidogrel, while there were 16 extensive metabolizers (26.23%), 19 intermediate metabolizers (31.15%) and 26 poor metabolizers (42.62%) for clopidogrel in the poor prognosis group, with a significant difference between the two groups (P < 0.05). In the good prognosis group, 234 cases were aspirin-sensitive (98.74%), 2 semi-responders (0.84%) and 1 aspirin-resistant (0.42%). However, in the poor prognosis group, 56 cases were aspirin-sensitive (91.80%), 3 semi-responders (4.92%) and 2 aspirin-resistant (3.28%), which was significantly different in comparison to the good prognosis group (P < 0.05).Conclusions The CYP2C19, PTGS1 and GP1BA gene polymorphisms have an effect on the prognosis of cerebral infarction patients in antiplatelet therapy with clopidogrel and aspirin. Thus, the detection of CYP2C19, PTGS1 and GP1BA gene polymorphisms is of great significance in predicting the prognosis of cerebral infarction patients undergoing antiplatelet therapy.