摘要
目的:探讨CYP2C19基因多态性联合血栓弹力图（TEG）在大动脉粥样硬化型非致残性缺血性脑血管事件（NICE）患者抗血小板治疗中的价值。方法:收集2020年3月至2021年9月入住郑州大学附属洛阳中心医院神经内科的150例初发的大动脉粥样硬化型NICE患者，随机将其分为观察组（75例）和对照组（75例）。观察组根据CYP2C19基因结果行不同剂量双联抗血小板聚集治疗21 d，21 d后依据TEG结果（氯吡格雷有效组54例，氯吡格雷抵抗组21例）选择有效药物或新型抗血小板药物；对照组常规剂量双联抗血小板聚集，21 d后随机选择单药给予抗血小板聚集治疗。对比2组患者缺血性脑卒中复发率及出血事件发生情况。结果:观察组中氯吡格雷有效组及抵抗组CYP2C19基因及TEG检测结果分别比较，差异均有统计学意义（Z=5.374，P＜0.001；Z=6.572，P＜0.001）。观察组缺血性脑卒中复发率显著低于对照组，2组间差异有统计学意义（9.33% vs 21.33%，P＜0.05）；观察组出血事件发生率为14.7%，对照组出血事件发生率为8.0%，2组间差异无统计学意义（P＞0.05）。结论:在大动脉粥样硬化型NICE患者的二级预防中，根据CYP2C19基因多态性筛选抗血小板药物，通过TEG评估抗血小板治疗的效果，可有效降低卒中复发率，且不增加出血风险。
Abstract
Objective:To investigate the value of CYP2C19 gene polymorphism combined with thromboelastogram (TEG) -guided antiplatelet therapy for non-disabling ischemic cerebrovascular events (NICE) with large artery atherosclerosis.Methods:A total of 150 patients with initial NICE in Department of Neurology in Luoyang Central Hospital Affiliated to Zhengzhou University from March 2020 to September 2021 were randomly divided into the observation group (75 cases) and the control group (75 cases). The observation group received different doses of dual antiplatelet therapy for 21 days according to CYP2C19 gene results, and effective drugs or new antiplatelet drugs were selected according to TEG results after 21 days (54 patients in Clopidogrel effective subgroup and 21 patients in Clopidogrel resistance subgroup). The control group received conventional dose of dual antiplatelet therapy, and was randomly selected for single antiplatelet therapy after 21 days. The recurrence of ischemic stroke and the occurrence of bleeding events were compared between the two groups.Results:The CYP2C19 genes and TEG tests in Clopidogrel effective and resistance subgroup of the observation group were observed and be significantly, respectively (Z=5.374, P＜0.001; Z=6.572, P＜0.001). The recurrence of stroke in the observation group (9.33%) was significantly lower than that in the control group (21.33%), and the difference between the two groups was statistically significant (P＜0.05). The incidence of bleeding events was 6.67% in the observation group and 5.33% in the control group, and there was no significant difference between the two groups (P＞0.05).Conclusion:In the secondary prevention of non-disabling cerebral infarction with large artery atherosclerosis, anti-platelet drugs screened according to CYP2C19 gene polymorphism and the effect of antiplatelet therapy evaluated by TEG can effectively reduce the recurrence rate of stroke without increasing the risk of bleeding.
基金项目
河南省2023年科技发展计划项目(232102310101)
万方数据