CYP2C19基因多态性与急性缺血性脑血管病的关系的研究

发布时间：2018-03-09 03:00

本文选题：CYP2C19　切入点：基因多态性　出处：《青岛大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:研究TIA患者90天内发生脑梗死与未发生脑梗死患者之间CYP2C19基因多态性的关系以及急性脑梗死患者1周内脑梗死进展与脑梗死未进展患者之间的CYP2C19基因多态性的关系。方法:选取2015.11-2016.9之间在枣庄市立医院急诊科与神经内科住院的TIA患者118例,按照90天内是否发生脑梗死分为发生脑梗死组和未发生脑梗死组,同期的急性脑梗死患者179例,按照1周内是否进展分为脑梗死进展组和脑梗死未进展组。所有患者入院后予阿司匹林及氯吡格雷联合联合抗血小板治疗,入院第二天抽空腹血查血糖、血脂、肝肾功能、血常规及凝血检查,并抽空腹血5ml应用荧光染色原位杂交测序检测法检测各组患者的CYP2C19基因型。计量资料用均数加减标准差(x±S)形式表示,并进行t检验,计数资料采用率和构成比,组间比较采用c2检验;如果两组数据比较P0.05,则认为两组对比数据之间的差异有显著统计学意义。采用Logistic回归分析TIA发生脑梗死的危险因素及急性脑梗死进展的危险因素P0.05为有显著统计学意义。结果:TIA患者90天内发生脑梗死28例,未发生脑梗死90例。两组患者在年龄、性别、血压、血糖、血脂等方面的差异均无统计学意义(P0.05)。发生脑梗死组EM型患者(21.4%)显著低于未发生脑梗死组(56.7%)(P0.01),而发生脑梗死组PM型患者(35.7%)显著高于未发生脑梗死组(10%)(P0.01)。IM型患者两者间无明显差异(P0.05)。急性脑梗死1周内进展患者44例,脑梗死未进展患者135例。两组患者在年龄、性别、血压、血糖、血脂等方面的差异均无统计学意义(P0.05)。脑梗死进展组EM型患者(29.5%)显著低于未发生脑梗死组(60%)(P0.01),脑梗死进展组PM型患者(25%)显著高于未发生脑梗死组(6.7%)(P0.01),IM型患者两者间无明显差异(P0.05)。Logistic回归分析显示,CYP2C19基因多态性与TIA发生脑梗死和急性脑梗死进展独立相关。结论:CYP2C19基因EM型的TIA患者90内不易发生脑梗死,PM型患者容易发生脑梗死;急性脑梗死患者CYP2C19基因PM型容易发生进展,而EM型患者不易发生进展。CYP2C19基因多态性是TIA发生脑梗死和急性脑梗死进展的独立危险因素。意义:随着科技进步及精准医学的发展,基因检测在临床医学中的应用越来越多。近年来对CYP2C19基因的研究越来越深入,越来越多的人把焦点集中到CYP2C19基因多态性与缺血性心脑血管疾病的发病原因和危险分层上来。最近有研究发现携带CYP2C19突变基因是冠心病发病的一个独立危险因素,本文研究了CYP2C19基因多态性与TIA发生脑梗死及急性脑梗死进展之间的关系,发现CYP2C19基因多态性是TIA发生脑梗死和急性脑梗死进展的独立危险因素,对于疾病的治疗、预后的判断及预防有着重要的指导意义。
[Abstract]:Objective: to study the relationship between the polymorphism of CYP2C19 gene in patients with cerebral infarction and those without cerebral infarction within 90 days in patients with TIA and the polymorphism of CYP2C19 gene between patients with acute cerebral infarction and patients with cerebral infarction within one week. Methods: a total of 118 patients with TIA were enrolled in emergency department and neurology department of Zaozhuang Municipal Hospital between May and June 2016.Methods: a total of 118 TIA patients were enrolled in this study. According to whether or not cerebral infarction occurred within 90 days, there were 179 patients with acute cerebral infarction in the same period. All patients were treated with aspirin and clopidogrel combined with antiplatelet therapy after admission. Blood glucose, blood lipids, liver and kidney function were measured on the second day of admission. The CYP2C19 genotypes of patients in each group were detected by fluorescence staining in situ hybridization sequencing and 5ml of abdominal blood was detected by blood routine examination and coagulation examination. The measured data were expressed in the form of mean plus or minus standard deviation (x 卤S), and t test was performed. The rate and composition ratio of counting data were used, and c2 test was used for the comparison between groups. If the two groups were compared with P0.05, the difference between the two groups was statistically significant. Logistic regression analysis was used to analyze the risk factors of cerebral infarction in TIA and the risk factors of progression of acute cerebral infarction (P0.05). Results 28 cases of cerebral infarction occurred within 90 days in patients with TIA. No cerebral infarction occurred in 90 cases. Two groups of patients in age, sex, blood pressure, blood sugar, There was no significant difference in serum lipids and blood lipids in patients with acute cerebral infarction (P 0.05). The levels of serum lipid in EM patients with cerebral infarction were significantly lower than those in patients with no cerebral infarction (56.7% P 0.01), while those in PM type patients with cerebral infarction were 35.7m) significantly higher than those in patients without cerebral infarction (P 0.01.IM). 44 patients with acute cerebral infarction developed within one week. 135 patients with no progress of cerebral infarction. Two groups of patients in age, sex, blood pressure, blood sugar, There was no significant difference in serum lipids and blood lipids (P 0.05). There was no significant difference in serum lipids between patients with EM type and without cerebral infarction group (P 0.01) and PM type PM group with cerebral infarction progression group (P < 0.05), which was significantly higher than that with no cerebral infarction group with P 0.01IM type and without cerebral infarction group (P < 0.01). Logistic regression analysis showed that the polymorphism of CYP2C19 gene was independently correlated with the progression of cerebral infarction and acute cerebral infarction in TIA. Conclusion the PM type of cerebral infarction is not easy to occur in TIA patients with EM type of CYP2C19 gene within 90 years. In patients with acute cerebral infarction, the PM type of CYP2C19 gene is prone to progress, while the polymorphism of CYP2C19 gene is an independent risk factor for the progression of cerebral infarction and acute cerebral infarction in patients with acute cerebral infarction (ACI), while the polymorphism of CYP2C19 gene is an independent risk factor for the progression of cerebral infarction and acute cerebral infarction in patients with acute cerebral infarction. The application of gene detection in clinical medicine is more and more. In recent years, the research on CYP2C19 gene is more and more in-depth. More and more people are focusing on the relationship between CYP2C19 gene polymorphism and the pathogenesis and risk of ischemic cardiovascular and cerebrovascular diseases. Recently, it has been found that carrying the CYP2C19 mutation gene is an independent risk factor for coronary heart disease. The relationship between the polymorphism of CYP2C19 gene and the progression of cerebral infarction and acute cerebral infarction in TIA was studied. It was found that the polymorphism of CYP2C19 gene was an independent risk factor for the progression of cerebral infarction and acute cerebral infarction in TIA. The judgment and prevention of prognosis have important guiding significance.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743.3

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