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[1]陳朋,江錚,魏鋒,等.ABCB1、CYP2C19基因多態(tài)性與氯吡格雷治療急性腦梗死患者臨床療效的關(guān)系[J].福建醫(yī)藥雜志,2024,46(05):9-13.[doi:10.20148/j.fmj.2024.05.003]
　CHEN Peng,JIANG Zheng,WEI Feng,et al.Relationship between gene polymorphisms of ABCB1 and CYP2C19 and clinical efficacy of clopidogrel in patients with acute cerebral infarction[J].FUJIAN MEDICAL JOURNAL,2024,46(05):9-13.[doi:10.20148/j.fmj.2024.05.003]
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ABCB1、CYP2C19基因多態(tài)性與氯吡格雷治療急性腦梗死患者臨床療效的關(guān)系()
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《福建醫(yī)藥雜志》[ISSN:1002-2600/CN:35-1071/R]

卷:
46
期數(shù):
2024年05期
頁碼:
9-13
欄目:
臨床研究
出版日期:
2024-10-15

文章信息/Info

Title:
Relationship between gene polymorphisms of ABCB1 and CYP2C19 and clinical efficacy of clopidogrel in patients with acute cerebral infarction
文章編號:
1002-2600(2024)05-0009-05
作者:
陳朋; 江錚; 魏鋒; 蔣小玲
福建省福州市第二總醫(yī)院神經(jīng)內(nèi)科,福州 350007
Author(s):
CHEN Peng;  JIANG Zheng;  WEI Feng;  JIANG Xiaoling
Department of Neurology, Fuzhou Second General Hospital, Fuzhou, Fujian 350007, China
關(guān)鍵詞:
急性腦梗死;  氯吡格雷;  ABCB1;  CYP2C19;  基因多態(tài)性
Keywords:
acute cerebral infarction;  clopidogrel;  ABCB1;  CYP2C19;  gene polymorphisms
分類號:
R743.3
DOI:
10.20148/j.fmj.2024.05.003
文獻(xiàn)標(biāo)志碼:
B
摘要:
目的 探究三磷酸腺苷結(jié)合盒轉(zhuǎn)運(yùn)子B亞家族成員1(ABCB1)、細(xì)胞色素氧化酶P4502C19(CYP2C19)基因多態(tài)性與氯吡格雷治療急性腦梗死患者臨床療效的關(guān)系。方法 回顧性分析2018年10月至2020年10月在我院進(jìn)行基因多態(tài)性檢測的98例急性腦梗死患者的臨床資料,所有患者均在常規(guī)治療的基礎(chǔ)上采用氯吡格雷治療14 d,比較不同ABCB1、CYP2C19基因分型患者美國國立衛(wèi)生研究院卒中量表(NIHSS)評分、改良Ranking量表(mRS)評分、臨床療效、血小板抑制率差異,采用單因素分析和logistic回歸方程分析ABCB1、CYP2C19基因多態(tài)性與臨床療效的關(guān)系。結(jié)果 98例患者中,ABCB1野生型41例(41.84%),突變型57例(58.16%); CYP2C19快速代謝型39例(39.80%),中間代謝型42例(42.86%),慢代謝型17例(17.34%)。治療14 d后,ABCB1、CYP2C19基因多態(tài)性患者的NIHSS、mRS評分均降低(P<0.05),且ABCB1野生型NIHSS、mRS評分低于突變型(P<0.05),CYP2C19快速代謝型NIHSS、mRS評分低于中間代謝型和慢代謝型(P<0.05)。治療14 d后,ABCB1、CYP2C19基因多態(tài)性患者臨床療效各等級差異均有統(tǒng)計(jì)學(xué)意義(P<0.05),但臨床總有效率差異無統(tǒng)計(jì)學(xué)意義(P>0.05)。不同ABCB1、CYP2C19基因類型患者血小板抑制率差異有統(tǒng)計(jì)學(xué)意義(P<0.05)。ABCB1野生型血小板抑制率高于突變型(P<0.05),CYP2C19快速代謝型血小板抑制率高于慢代謝型(P<0.05)。不同ABCB1、CYP2C19基因突變患者性別、年齡、身體質(zhì)量指數(shù)、合并基礎(chǔ)疾病、既往史差異無統(tǒng)計(jì)學(xué)意義(P>0.05)。logistic分析結(jié)果顯示,ABCB1突變型、CYP2C19中間代謝型和CYP2C19慢代謝型均為急性腦梗死臨床療效的影響因素(P<0.05)。結(jié)論 ABCB1、CYP2C19基因多態(tài)性可能會增加急性腦梗死患者的氯吡格雷抵抗,其中ABCB1突變型、CYP2C19中間代謝型和CYP2C19慢代謝型均為急性腦梗死臨床療效的影響因素。
Abstract:
Objective To explore the relationship between gene polymorphisms of adenosine triphosphate binding cassette ransporter B1(ABCB1)and cytochrome P450 2C19(CYP2C19)and clinical efficacy of clopidogrel in patients with acute cerebral infarction. Methods The clinical data of 98 patients with acute cerebral infarction who underwent gene polymorphism detection in the hospital from October 2018 to October 2020 were retrospectively analyzed. All patients were treated with clopidogrel for 14 days on the basis of conventional treatment. The differences in National Institutes of Health Stroke Scale(NIHSS)score,modified Ranking scale(mRS)score, clinical efficacy and platelet inhibition rate were compared among patients with different ABCB1 and CYP2C19 genotypes. Univariate analysis and logistic regression equation were used to analyze the relationship between gene polymorphisms of ABCB1 and CYP2C19 and clinical efficacy. Results Among the 98 patients, there were 41 cases(41.84%)of ABCB1 wild type, 57 cases(58.16%)of ABCB1 mutant type; 39 cases(39.80%)of CYP2C19 fast metabolic type, 42 cases(42.86%)of intermediate metabolic type and 17 cases(17.34%)of slow metabolic type. After 14 days of treatment, the scores of NIHSS and mRS of patients with ABCB1 and CYP2C19 gene polymorphisms were decreased(P<0.05), and the NIHSS score and mRS score of ABCB1 wild type were lower than those of mutant type(P<0.05), and the scores of CYP2C19 fast metabolic type were lower than those of intermediate metabolic type and slow metabolic type(P<0.05). After 14 days of treatment, there was a statistical difference in each grade of clinical efficacy among patients with ABCB1 and CYP2C19 gene polymorphisms(P<0.05), but there was no statistical significance in the total clinical effective rate(P>0.05). The difference in platelet inhibition rate was statistically significant among patients with different ABCB1 and CYP2C19 genotypes(P<0.05). The platelet inhibition rate of ABCB1 wild type was higher than that of ABCB1 mutant type(P<0.05), and the platelet inhibition rate of CYP2C19 fast metabolic type was higher than that of CYP2C19 slow metabolic type(P<0.05). No statistical differences were shown in gender, age, body mass index,underlying diseases and past history among patients with different ABCB1 and CYP2C19 gene mutations(P>0.05). Logistic analysis showed that ABCB1 mutant type, CYP2C19 intermediate metabolic type and CYP2C19 slow metabolic type were influencing factors of clinical efficacy of acute cerebral infarction(P<0.05). Conclusion Gene polymorphisms of ABCB1 and CYP2C19 may increase clopidogrel resistance in patients with acute cerebral infarction, and ABCB1 mutant type, CYP2C19 intermediate metabolic type and CYP2C19 slow metabolic type are all influencing factors of clinical efficacy of acute cerebral infarction.

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備注/Memo

備注/Memo:
基金項(xiàng)目:福州市科技計(jì)劃社會發(fā)展項(xiàng)目(2018-S-101-2)
更新日期/Last Update: 2024-10-15