CYP2C19基因多态性指导下的抗血小板个体化治疗急性脑梗死的临床观察

摘要

目的 探讨CYP2C19基因多态性指导下的抗血小板个体化治疗对急性脑梗死病人疗效的影响.方法 前瞻性纳入非心源性急性脑梗死的病人100例,根据CYP2C19基因多态性分为常规治疗组、慢代谢个体化治疗组和慢代谢常规治疗组,常规治疗组和慢代谢常规治疗组给予阿司匹林+氯吡格雷治疗,慢代谢个体化治疗组给予阿司匹林+氯吡格雷+西洛他唑治疗.三组病人疗程均为15 d,比较各组病人疗效、美国国立卫生院卒中量表(NIHSS)评分及主要出血事件的发生率.结果 各组病人性别、年龄、原发性高血压、糖尿病、高脂血症等方面,均差异无统计学意义(P>0.05);常规治疗组与慢代谢个体化治疗组的有效率分别为84.00%和76.67%,差异无统计学意义(P>0.05),两组的出血事件及其他不良反应均差异无统计学意义(P>0.05);慢代谢常规治疗组对血小板的抑制率低于慢代谢个体化治疗组,差异有统计学意义(P<0.05).结论 联合使用西洛他唑可以克服氯吡格雷抵抗,根据基因指导抗血小板治疗急性脑梗死的疗效良好.%Objective To investigate the therapeutic efficacy of anti-platelet individual treatment guided by CYP2C19 polymorphism on patients with acute cerebral infraction.Methods 100 patients with acute cerebral infraction were chosen.All patients were randomly divided into routine group,slow metabolic individual treatment group and slow metabolic individual group by CYP2C19 polymorphism.The routine group and slow metabolic individual group were treated with aspirin+clopidogrel for anti-platelet treatment,and the slow metabolic individual group was treated with aspirin+clopidogrel+cilostazol for anti-platelet treatment.Treatment course of 3 groups lasted for 15 days.The clinical effects,NIHSS and the incidence of major bleeding events were compared between 3 groups before and after treatment.Results There were no statistical differences in sex,age,hypertension,diabetes and hyperlipidemia between these groups.The effective rates of the individual group and the routine were 76.67% and 84.00%.There was no statistical difference in major bleeding events and adverse effects between the two groups.The inhibition rate of slow metabolic routine treatment group on platelet was lower than those of the slow metabolic individual therapy group.Conclusion The use of combination therapy with clopidogrel and cilostazol may be one means of overcoming clopidogrel resistance.The anti-platelet individual treatment guided by polymorphism can increase curative effects of clopidogrel in patients with acute cerebral infarction.