氯吡格雷疗效与细胞色素P450 2C19基因多态性在急性脑梗死患者的相关研究

发布时间：2018-02-28 07:03

本文关键词： 脑梗死细胞色素P C 氯吡格雷 C-反应蛋白　出处：《中国临床药理学杂志》2017年03期 　论文类型：期刊论文

【摘要】：目的观察急性脑梗死患者氯吡格雷疗效与细胞色素P450 2C19(CYP2C19)基因多态性的关系及其对高敏C-反应蛋白(hs-CRP)的影响。方法入选急性脑梗死患者212例,进行CYP2C19基因检测,按照检测结果分为A、B、C组。A组为快代谢型(*1/*1)87例,B组为中间代谢型(*1/*2,*1/*3)74例和C组为慢代谢型(*2/*2,*2/*3,*3/*3)51例,3组患者均口服首次负荷剂量的氯吡格雷300 mg,每天1次,第2天开始口服氯吡格雷75 mg,每天1次维持治疗。3组患者均连续治疗7 d。比较3组患者的临床疗效、治疗前后的血小板聚集率(PAG)、hs-CRP水平和药物不良反应的发生情况。结果治疗后,A、B、C组的总有效率分别为96.55%(84/87例)、87.84%(65/74例)和78.43%(40/51例),差异有统计学意义(P0.05)。治疗后,A、B、C组的PAG分别为(29.52±10.60)%,(43.31±10.63)%,(61.67±10.12)%;hs-CRP分别为(1.77±0.54),(2.93±0.68),(4.57±1.03)mg·L-1,与治疗前相比,差异均有统计学意义(P0.05)。B、C组PAG和hs-CRP与A组相比,差异有统计学意义(P0.05)。A组出现牙龈出血2例,皮肤黏膜下出血点1例,药物不良反应发生率为3.45%(3/87例);B组出现牙龈出血2例,药物不良反应发生率为2.70%(2/74例);C组出现牙龈出血1例,药物不良反应发生率为1.96%(1/51例)。3组药物不良反应发生率差异无统计学意义(P0.05)。结论急性脑梗死患者的CYP2C19基因多态性和氯吡格雷的疗效相关,慢代谢型患者的氯吡格雷疗效减弱可能与削弱了药物的抗炎作用有关。
[Abstract]:Objective to investigate the relationship between clopidogrel efficacy and cytochrome P450 2C19 CYP2C19 gene polymorphism in patients with acute cerebral infarction and its effect on Gao Min C- reactive protein hs-CRP. Methods 212 patients with acute cerebral infarction were selected to detect the CYP2C19 gene. According to the test results, the patients in group A were divided into two groups: group A, rapid metabolic group (n = 87), group B (n = 87), intermediate metabolic type (n = 74, n = 74), and group C (n = 74), slow metabolic type (n = 2, n = 2) and group C (n = 351, n = 351) with a first-load dose of clopidogrel 300 mg, once a day. On the second day, clopidogrel 75 mg was taken orally. The patients in group 3 were treated continuously for 7 days once a day. The clinical efficacy of the three groups was compared. Before and after treatment, the platelet aggregation rate and the level of PAGG hs-CRP and the occurrence of adverse drug reactions were observed. Results the total effective rates of group A were 96.5555 / 84 / 87 (87.84 / 65 / 74) and 78.4343 / 4051 (P < 0.05), respectively. 43.31 卤10.63 and 61.67 卤10.12 hs-CRP were 1.77 卤0.54, 2.93 卤0.68 and 4.57 卤1.03mg 路L -1, respectively, compared with those before treatment. There were significant differences in PAG and hs-CRP between group A and group A. There were two cases of gingival bleeding and one case of bleeding point under skin mucosa in group A. The incidence of adverse drug reactions was 3.455U / 3 / 87 cases of gingival bleeding in group B (2 cases). The incidence of adverse drug reactions was 2.70 / 74 cases of gingival hemorrhage in group C (1 case). There was no significant difference in the incidence of adverse drug reactions between 1.96 / 51 patients and 51 patients with acute cerebral infarction. Conclusion the polymorphism of CYP2C19 gene in patients with acute cerebral infarction is related to the efficacy of clopidogrel. The decreased efficacy of clopidogrel in slow metabolic patients may be associated with weakening the anti-inflammatory effect of the drug.
【作者单位】：武汉大学同仁医院武汉市第三医院神经内科;
【基金】：武汉市卫生计生委科研基金资助项目(WX15C12)
【分类号】：R743.33

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