非心源性 TIA 患者服用氯吡格雷后短期内缺血性脑卒中复发与 CYP2 C19 基因多态性的关系

摘要

Objective To investigate the relationship between the recurrence of ischemic stroke in short period after taking clopidogrel and the CYP2C19 gene polymorphisms in non-cardiogenic TIA patients.Methods Eighty-two patients with first onset non-cardiogenic TIA were given 21 d of clopidogrel plus aspirin treatment at first, then only clopidogrel treatment, and the total duration of treatment was 90 d.They were divided into stroke recurrence group and non-stroke recurrence group according to whether the ischemic stroke recurred or not.The genotypes of CYP2C19 were detected with CYP2C19 gene chip.Results Stroke recurrence group was 39 cases, and non-stroke recurrence group was 43 cases.There were no significant differences in age, sex, hypertension, diabetes and blood lipids between the two groups (all P>0.05).The CYP2C19*1 allele and CYP2C19*1/*1 genotype frequencies of the non-stroke recurrence group (76.7%, 60.5%) were significantly higher than those in stroke recurrence group (41.0%, 20.5%)(all P<0.01).The CYP2C19*2 allele and CYP2C19*2/*2 genotype frequencies of the non-stroke recurrence group (17.4%, 2.3%)were significantly lower than those in stroke recurrence group (53.9%, 30.8%)(all P<0.01).The other alleles and genotypes frequencies were no significant differences between the two groups (all P>0.05).Extensive metabolizer proportion of the non-stroke recurrence group was significantly higher than that of the stroke recurrence group ( P<0.001);while poor metabolizer proportion of the non-stroke recurrence group was significantly lower than that of the stroke recurrence group (P=0.001);and the intermediate metabolizer proportions between the two groups were of no difference ( P=0.427) .Conclusion Recurrence of ischemic stroke in short period in patients taking clopidogrel after the first non-cardiogenic TIA is associated with the mutation of CYP2C19 gene.%目的 探讨非心源性TIA患者服用氯吡格雷后短期内缺血性脑卒中复发与CYP2C19基因多态性的关系. 方法 对82例初发非心源性TIA患者给予氯吡格雷联合阿司匹林治疗21 d,随后氯吡格雷单药治疗,总疗程90 d. 根据是否复发缺血性脑卒中将其分为卒中复发组与卒中未复发组,通过CYP2C19基因芯片对两组患者的CYP2 C19基因型进行检测. 结果 卒中复发组39例,卒中未复发组43例. 两组患者在年龄、性别、高血压、糖尿病、血脂等的差异均无统计学意义(均P>0.05). 卒中未复发组CYP2C19 *1等位基因频率(76.7%)及CYP2C19*1/*1基因型频率(60.5%)显著高于卒中复发组(41.0%, 20.5%)(均P<0. 01). 卒中未复发组CYP2C19*2 等位基因频率(17.4%)及CYP2C19*2/*2基因型频率(2.3%)则显著低于卒中复发组(53.9%, 30.8%)(均P<0.01). 两组间其它等位基因及基因型频率的差异无统计学意义(均P>0.05). 卒中未复发组强代谢型的比例显著高于卒中复发组(P<0.001);而弱代谢型的比例却显著低于卒中复发组(P=0.001);两组间中间代谢型的比例差异无统计学意义(P=0.427). 结论 非心源性TIA患者服用氯吡格雷后短期内缺血性脑卒中复发与CYP2C19基因多态性有关.