氯吡格雷在老年缺血性脑卒中患者的应用及CYP2C19 基因多态性对预后的影响

目的 探讨氯吡格雷在老年缺血性脑卒中患者中的应用及细胞色素P4502C19(CYP2C19)基因多态性对预后的影响.方法 选取收治的老年缺血性脑卒中患者144例,依据氯吡格雷抵抗情况将这些患者分为抵抗组(n=45)和非抵抗组(n=99)两组,测定两组患者的血小板聚集功能并检测其基因型,然后对2个单核苷酸多态性(SNPs)的等位基因频率及基因型频率、两组患者的2个SNPs分布情况进行统计分析.结果 CYP2C19(636G>A,rs4986893)(681G>A,rs4244285)等位基因及基因频率均和Hardy-Weinberg相符(P>0.05);抵抗组患者的CYP2C19?2(rs4244285)GG型分布率显著低于非抵抗组(P<0.05),GA+AA型分布率显著高于非抵抗组(P<0.05),且GA+AA型分布率显著高于GG型(P<0.05),但两组患者的CYP2C19?3(rs4986893)GG型、AG+AA型分布率之间均差异无统计学意义(P>0.05).结论 老年缺血性脑卒中患者的氯吡格雷抵抗和CYP2C19?2(rs4244285)GA+AA型关系密切,检测该基因型能够为氯吡格雷的临床科学应用提供有效指导,值得临床充分重视.

Application of clopidogrel in elderly patients with ischemic stroke and influence of CYP2C19 gene polymorphism in prognosis

Objective To investigate the application of clopidogrel in elderly patients with ischemic stroke and influence of CYP2C19 gene polymorphism in prognosis. Methods One hundred and forty-four cases of elderly patients with ischemic stroke in department of neurology,Wuhan Third Hospital from May 2014 to May 2016 were selected. These patients were assigned into resistance group(n = 45) and non-resistance group(n = 99),according to the situation of clopidogrel resistance. The platelet aggregation of the two groups were measured and the genotype were detected. then the 2 SNPs allele frequency distribution,genotype frequency of 2 SNPs of the two groups were statistically analyzed. Results CYP2C19(636G > A,rs4986893)(681G > A,rs4244285) allele and gene frequency were consistent with Hardy-Weinberg(P >0. 05). The CYP2C19?2(rs4244285) GG distribution rate of the resistance group was significantly lower than the non-resistance group(P <0. 05),the GA + AA distribution rate was significantly higher than the non-resistance group(P <0. 05),and the GA + AA distribution rate was significantly higher than the GG(P <0. 05). However,the differences of the CYP2C19?3(rs4986893) GG type and AG + AA type distribution rates between the two groups were not significant(P >0. 05). Conclusions The relationship be-tween clopidogrel resistance and GA + AA(rs4244285) CYP2C19?2 of the elderly patients with ischemic stroke is close,the detection of the genotype can provide an effective guidance for the clinical application of clopidogrel,which is worthy of the clinical full attention.