CYP2C19基因多态性与脑梗死急性期中医证型的相关性研究

发布时间：2018-04-27 21:02

本文选题：脑梗死 + CYP2C19基因多态性　；参考：《成都中医药大学》2016年硕士论文

【摘要】：目的：通过对脑梗死急性期患者CYP2C19基因代谢类型和中医证型的统计调查,探讨脑梗死急性期患者CYP2C19基因多态性与中医证型的相关性,为中医药从基因水平干预氯吡格雷抵抗,增强氯吡格雷的敏感性提供依据。方法：采用流行病学调查中横断面研究的方法,随机选取2015年4月至2015年12月在成都中医药大学附属医院脑病科及四川省人民医院神经内科就诊的门诊和住院病人中符合纳入标准的脑梗死急性期患者,共151例。检测纳入患者的CYP2C19基因代谢类型,同时收集纳入患者的中医四诊资料,探讨CYP2C19基因多态性与中医证型的相关性。应用SPSS22.0软件对数据进行统计学分析。结果：本研究共纳入151例脑梗死急性期的患者,男性80例,女性71例,男女比例为1.13：1；年龄范围在46-80岁之间,平均年龄67.51±8.782岁；单纯糖尿病者27例,单纯高血压者60例,单纯高血脂者23例。共检出3种等位基因(CYP2C19*1、*2和*3)和6种等位基因型(CYP2C19*1/*1、*1/*2、*1/*3、*2/*2、*2/*3、*3/*3), CYP2C19*1、*2和*3等位基因的分布频率分别是59.93%,34.44%,5.63%。所有入组患者的中医证型分为5种：风痰瘀阻、肝阳暴亢、痰热腑实、气虚血瘀和阴虚风动。在性别、年龄段对CYP2C19基因多态性的影响方面,CYP2C19等位基因、基因型型及基因代谢类型在不同性别和不同年龄段(中年、老年早期和老年)的分布无显著差异(P0.05)。在中医证型分布方面,中风中经络急性期风痰瘀阻证所占比例最大(P0.005),合并中医证型为实证和虚证后实证所占比例最大(P0.05)。在中医证型分布的影响因素方面,性别、年龄、血压、血脂和吸烟不是影响中医证型分布的主要因素(P0.05),血糖异常可能影响中医证型的分布(P0.05)。CYP2C19基因多态性与中医证型的相关性方面：1)相对于中医证型为气虚血瘀证而不是阴虚风动证的患者,快代谢类型(Extensive metabolizer,EM型)与慢代谢类型(Poor metabolizer,PM型)及野生型与突变型等位基因相比,差异有统计学意义(P0.05)。基因代谢类型表现为EM型的是PM型的0.104倍,携带野生型等位基因的是携带突变型的0.264倍；2)将EM型和中等代谢类型(Intermediatemetabolizer,IM型)合并,分析合并后基因代谢类型(EM+IM型、PM型)与中医证型的相关性,结果显示差异有统计学意义(P0.05,OR=4.185)。相对于中医证型为气虚血瘀证而不是阴虚风动证,基因代谢类型表现为PM型的是表现为EM+IM型的4.185倍：3)合并中医证型为实证和虚证,结果显示基因代谢类型为EM型、IM型与PM型相比较,差异有统计学意义(P_1、P_20.05, OR_1=7.955,OR_2=4.136)。EM型和IM型中,表现为实证的患者是PM型中表现为实证的7.955倍和4.136倍。结论：1.脑梗死多发于中老年群体,发病率男性略高于女性,常合并其他慢性基础性疾病。2.CYP2C19*1、*2和*3等位基因的频率分别是59.93%,34.44%,5.63%。与CYP2C19*3相比较,*2是最常见的功能缺失型等位基因。3.性别和年龄不是影响中老年群体CYP2C19基因多态性和中医证型分布的因素。4.实证是中风中经络急性期最常见的中医证型,尤其是风痰瘀阻证。5.血压、血脂、吸烟不是影响中风中经络急性期中医证型分布的因素,血糖异常可能影响中医证型的分布,尤其是痰热证。6.CYP2C19基因多态性与中医证型的相关性方面：脑梗死急性期患者CYP2C19基因多态性与中医证型存在相关性,携带功能缺失等位基因及PM型患者中医证型更多的表现为气虚血瘀证；与PM型相比较,EM型和IM型患者中,实证较虚证更为常见。
[Abstract]:Objective: To explore the correlation between the polymorphism of CYP2C19 gene and TCM syndrome type in acute cerebral infarction by the statistical investigation of the type of CYP2C19 gene metabolism and TCM syndrome type in acute cerebral infarction, and to provide the basis for the intervention of clopidogrel and the sensitivity of clopidogrel. The methods of cross-sectional study in the study were randomly selected from April 2015 to December 2015 at the outpatient and hospitalized patients in the neurology department of the Affiliated Hospital of Chengdu University of Traditional Chinese Medicine and the Sichuan Provincial People's Hospital in the Department of Neurology of Sichuan Provincial People's Hospital. 151 cases were conformed to the standard of cerebral infarction, and the types of CYP2C19 gene metabolism were detected. The four diagnosis data of Chinese medicine were collected and the correlation between CYP2C19 gene polymorphism and TCM syndrome type was investigated. The data were statistically analyzed with SPSS22.0 software. Results: 151 patients with acute cerebral infarction were included in this study, 80 males and 71 females, and the male and female ratio was 1.13:1; the age range was between 46-80 years and average year. Age 67.51 + 8.782 years, 27 cases of simple diabetes, 60 cases of simple hypertension, 23 cases of simple hyperlipidemia, 3 alleles (CYP2C19*1, *2 and *3) and 6 alleles (CYP2C19*1/*1, *1/*2, *1/*3, *2/*2, *2/*3, *3/*3), CYP2C19*1, *2, and *3 alleles were 59.93%, 34.44%, respectively. There are 5 kinds of TCM syndrome types: wind phlegm stasis, hyperactivity of liver Yang, phlegm and heat, Qi deficiency and blood stasis and yin deficiency. There is no significant difference in the distribution of CYP2C19 alleles, genotypes and types of gene metabolism in different sex and age groups (middle age, early age and old age) in gender and age group (P0.05) In the distribution of TCM syndrome type, the proportion of wind phlegm stasis syndrome in acute phase of meridian and collaterals in stroke is the largest (P0.005), and the proportion of TCM syndrome type is the largest (P0.05). In the influence factors of TCM syndrome type distribution, sex, age, blood pressure, blood fat and smoking are not the main factors affecting the distribution of TCM syndrome (P0.05). Abnormal blood glucose may affect the correlation of P0.05.CYP2C19 gene polymorphism and TCM Syndrome Type: 1) relative to patients with Qi deficiency and blood stasis syndrome rather than Yin deficiency syndrome, fast metabolic type (Extensive metabolizer, EM type) and slow metabolite type (Poor metabolizer, PM type), wild type and mutant type, etc. The difference was statistically significant (P0.05). The type of gene metabolism was 0.104 times that of type EM, 0.264 times that of the mutant, and 2) combined EM and secondary metabolic types (Intermediatemetabolizer, IM), and analyzed the type of gene metabolism (EM+IM, PM) and TCM syndrome type after the combination of the type of gene metabolism (EM+IM, PM type) and TCM syndrome type. Correlation, the results showed that the difference was statistically significant (P0.05, OR=4.185). Relative to TCM syndrome type was Qi deficiency and blood stasis syndrome, not Yin deficiency syndrome, the type of gene metabolism was 4.185 times that of type EM+IM, 3) the combination of TCM syndrome type was positive and false, the result showed that the type of gene metabolism was EM, IM type and PM type were compared. The difference was statistically significant (P_1, P_20.05, OR_1=7.955, OR_2=4.136) in.EM and IM type, and the patients shown as positive were 7.955 times and 4.136 times the positive in the PM type. Conclusion: 1. cerebral infarction is mostly in the middle and old age group, the incidence of the male is slightly higher than that of the female, and the other chronic basic diseases,.2.CYP2C19*1, *2 and *3 alleles are often combined. The frequency is 59.93%, 34.44%, and 5.63%. is compared with CYP2C19*3. *2 is the most common functional deletion allele.3. sex and age are not the factors affecting the CYP2C19 gene polymorphism and the distribution of TCM syndrome type..4. is the most common syndrome type in the acute phase of the meridian and collaterals in the stroke, especially the blood pressure and blood lipid of the wind phlegm stasis syndrome, and the blood lipid. Smoking is not a factor affecting the distribution of TCM syndrome type in acute phase of apoplexy. Abnormal blood glucose may affect the distribution of TCM syndrome type, especially the correlation between.6.CYP2C19 gene polymorphism of phlegm heat syndrome and TCM Syndrome Type: there is a correlation between CYP2C19 gene polymorphism and TCM syndrome type in acute cerebral infarction, and the loss of function is carried in the patients with acute cerebral infarction. The TCM Syndromes of patients with genotype and PM were more manifested as Qi deficiency and blood stasis syndrome. Compared with type PM, EM and IM patients were more common than deficiency syndrome.

【学位授予单位】：成都中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R743.33

【相似文献】