氯吡格雷治疗急性脑梗死病人CYP2C19基因多态性检测的临床意义

骆嵩; 杨丽娟; 屈洪党

doi:10.13898/j.cnki.issn.1000-2200.2018.09.005

氯吡格雷治疗急性脑梗死病人CYP2C19基因多态性检测的临床意义

1. 蚌埠医学院第一附属医院神经内科, 安徽蚌埠 233004;
2. 蚌埠医学院第一附属医院儿科, 安徽蚌埠 233004

作者简介: 骆嵩(1986-),男,主治医师.

基金项目:
蚌埠医学院自然科学基金面上项目（BYKY1790）
中图分类号: R743.3

Clinical significance of the detection of CYP2C19 gene polymorphism in acute cerebral infarction patients treated with clopidogrel

1. Department of Neurology, The First Affiliated Hospital of Bengbu Medical College, Bengbu Anhui 233004, China;
2. Department of Pediatrics, The First Affiliated Hospital of Bengbu Medical College, Bengbu Anhui 233004, China
CLC number: R743.3

摘要: 目的：探讨CYP2C19基因多态性检测指导急性脑梗死治疗的意义及其与脑梗死进展之间的关系。方法：急性脑梗死病人206例，入院后完善相关病史资料、体格检查、常规入院检验检查，以及CYP2C19基因检测等项目，按照临床症状进展与否，分为脑梗死进展组和非进展组，据此进一步分析CYP2C19基因检测中的快代谢型、中间代谢型和慢代谢型，其在常规联合抗血小板治疗中对于脑梗死病人临床转归的作用，并进行统计学分析。结果：2组病人CYP2C19基因代谢类型分布差异有统计学意义（P<0.01），进展组病人PM型比例较高，EM型比例较低。结论：CYP2C19基因多态性可能与缺血性脑卒中病人氯吡格雷治疗后病情进展有关。
- 缺血性脑卒中 /
- 氯吡格雷 /
- CYP2C19基因 /
- 神经功能缺损
Abstract: Objective:To investigate the significance of the detection of CYP2C19 gene polymorphism in guiding the treatment of acute cerebral infarction(ACI),and its correlation with the progress of ACI.Methods:The disease history,physical examination,routine admission test and CYP2C19 gene detection in 206 ACI patients were analyzed,and the patients were divided into the progressive cerebral infarction group and non-progressive group according to clinical symptoms.The fast metabolism,intermediate metablism and slow metabolism in the detection of CYP2C19 gene were further analyzed,and the effects of which on the clinical outcome of ACI patients treated with conventional method combined with antiplatelet was statistically analyzed.Results:The difference of the metablism type distribution of CYP2C19 gene between two groups was statistically significant(P<0.01),and the ratios of PM and EM genotypes in progressive cerebral infarction group were higher and lower than those in non-progressive group,respectively.Conclusions:The CYP2C19 gene polymorphism may be related to the disease progress in ischemic stroke patients treated with clopidogrel.
- ischemic stroke /
- clopidogrel /
- CYP2C19 gene /
- neurological deficit

[1]	中华医学会神经病学分会脑血管病学组缺血性脑卒中二级预防指南撰写组.中国缺血性脑卒中和短暂性脑缺血发作二级预防指南2010[J].中华神经科杂志,2010,43(2):154.
[2]	KERNAN WN,OVBIAGELE B,BLACK HR,et al.Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack:a guideline for healthcare professionals from the American Heart Association/American Stroke Association[J].Stroke,2014,45(7):2160.
[3]	ERIKSSON P.Creative cost-effectiveness analysis of CAPRIE data dust in our eyes[J].Am J Med,2005,118:199.
[4]	HO PM,MADDOX TM,WANG L,et al.Risk of adverse outcomes associated with concomitant use of clopidogrel and proton pump inhibitors following acute coronary syndrome[J].JAMA,2009,301:937.
[5]	SOFI F,MARCUCCI R,GORI AM,et al.Clopidogrel non-responsiveness and risk of cardiovascular morbidity.An updated meta-analysis[J].Thromb Haemost,2010,103:841.
[6]	NGUYEN TA,DIODAT JQ,PHARAND C.Resistance to clopidogrel:a review of the evidence[J].J Am Coll Cardiol,2005,45:1157.
[7]	SCOTT SA,SANGKUHL K,GARDNER EE,et al.Clinical pharmacogenetics implementation consortium guidelines for cytochrome P450-2C19(CYP2C19) genotype and clopidogrel therapy[J].Clin Pharmacol Ther,2011,90(2):328.
[8]	KAZUI M,NISHIYA Y,ISHIZUKA T,et al.Identification of the human cytochrome P450 enzymes involved in the two oxidative steps in the bioactivation of clopidogrel to its pharmacologically active metabolite[J].Drug Metab Dispos,2009,38(1):92.
[9]	MEGA JL,CLOSE SL,WIVIOTT SD,et al.CytochromeP-450 polymorphisms and response to clopidogrel[J].Curr Atheroscler Rep,2009,360(3):2250.
[10]	MAN M,FARMEN M,DUMAUAL C,et al.Genetic variation in metabolizing enzyme and transporter genes:comprehensive assessment in 3 major East Asian subpopulations with comparison to Caucasians and Africans[J].J Clin Pharmacol,2010,50(8):929.
[11]	MORAIS SM,WILKINSON GR,BLAISDELL J,et al.The major genetic defect responsible for the polymorphism of S-mephenytoin metabolism in humans[J].J Biol Chem,1994,269(22):15419.
[12]	MEGA JL,CLOSE SL,WIVIOTT SD,et al.Cytochrome p-450 polymorphisms and response to clopidogrel[J].N Engl J Med,2009,360(4):3542.
[13]	MEGA JL,CLOSE SL,WIVIOTT SD,et al.Genetic variants in ABCB1 and CYP2C19 and cardiovascular outcomes after treatment with clopidogrel and prasugrel in the TRITON-TIMI 38 trial:a pharmacogenetic analysis[J].Lancet,2010,376(9749):1312.
[14]	COLLET JP,HULOT JS,PENA A,et al.Cytochrome P4502C19 polymorphism in young patients treated with clopidogrel after myocardial infarction:a cohort study[J].Lancet,2009,373(9660):309.
[15]	SHULDINER AR,O'CONNELL JR,BLIDEN KP,et al.Association of cytochrome P4502C19 genotype with the antiplatelet effect and clinical efficacy of clopidogrel therapy[J].JAMA,2009,302(8):849.

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氯吡格雷治疗急性脑梗死病人CYP2C19基因多态性检测的临床意义

作者简介: 骆嵩(1986-),男,主治医师.

Clinical significance of the detection of CYP2C19 gene polymorphism in acute cerebral infarction patients treated with clopidogrel

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氯吡格雷治疗急性脑梗死病人CYP2C19基因多态性检测的临床意义

作者简介: 骆嵩(1986-),男,主治医师.

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Clinical significance of the detection of CYP2C19 gene polymorphism in acute cerebral infarction patients treated with clopidogrel

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氯吡格雷治疗急性脑梗死病人CYP2C19基因多态性检测的临床意义

作者简介: 骆嵩(1986-),男,主治医师.

Clinical significance of the detection of CYP2C19 gene polymorphism in acute cerebral infarction patients treated with clopidogrel

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氯吡格雷治疗急性脑梗死病人CYP2C19基因多态性检测的临床意义

作者简介: 骆嵩(1986-),男,主治医师.

English Abstract

Clinical significance of the detection of CYP2C19 gene polymorphism in acute cerebral infarction patients treated with clopidogrel

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