基因多态性对急性脑梗死患者抗血小板聚集药物个体化用药的临床价值

目的研究阿司匹林、氯吡格雷、西洛他唑的药物基因多态性特点及其在脑梗死患者个体化给药中的临床应用价值。方法选取2018年12月-2019年6月就诊中国人民解放军联勤保障部队第九〇〇医院神经内科的139例急性脑梗死患者,所有患者入院后均口服硫酸氢氯吡格雷片75mg,1次/d,用药后均行阿司匹林、氯吡格雷、西洛他唑的药物基因检测,结合患者的一般信息对3种药物基因检测结果进行统计分析,依据基因检测结果和循证医学证据选择个体化抗血小板聚集药物治疗方案,记录患者住院期间和出院后90d使用抗血小板聚集药物出现的不良反应和临床疗效。结果在139例患者中,氯吡格雷中代谢、慢代谢的患者有83例,阿司匹林高抵抗的患者有52例,西洛他唑弱代谢型的患者有9例,其中对氯吡格雷抵抗的患者比例最高,达59.71%。合并基础疾病的患者中,糖尿病为氯吡格雷抵抗的独立危险因素之一,差异具有统计学意义(P<0.05),而对于阿司匹林、西洛他唑则无统计学差异。对于氯吡格雷抵抗的患者均按基因检测的结果调整抗血小板聚集药物治疗方案,所有患者随访90d均未出现新发的脑血管事件。结论抗血小板聚集药物基因多态性在急性脑梗死患者的治疗中具有重要的参考价值。

Clinical application of anti-platelet drug gene polymorphism in individualized administration of patients with acute cerebral infarction

Objective To study the polymorphisms of aspirin, clopidogrel, and cilostazol, and their clinical application value in individualized administration of patients with cerebral infarction. Methods Patients (139 cases) with acute cerebral infarction in 900 Hospital of the Joint Logistics Support Force of PLA from December 2018 to Jane 2019 were enrolled. Patients were po administered with Clopidogrel Hydrogen Sulfate Tablets, 75 mg/time, once daily. After the drug administration, aspirin, clopidogrel, and cilostazol were detected. The results of the three drug genes were combined with the general information of the patients. Statistical analysis based on genetic testing results and evidence-based medical evidences were used to select individualized antiplatelet regimens, and adverse reactions using antiplatelet agents during hospitalization and 90 d after discharge were recorded. Results In 139 patients, 83 patients had media-metabolic and slow-metabolism in clopidogrel, 52 patients had high aspirin resistance, and 9 patients had cilostazol metabolism, including patients who were resistant to clopidogrel. The proportion was the highest, reaching 59.71%. Diabetes was one of the independent risk factors for clopidogrel resistance, with statistically significant differences (P<0.05). For patients with clopidogrel resistance, antiplatelet regimens were adjusted according to the results of genetic testing. All patients had no cerebrovascular events in 90 d of follow-up. Conclusion Anti-platelet drug gene polymorphism has important reference value in the treatment of patients with acute cerebral infarction.