目的 研究阿司匹林、氯吡格雷、西洛他唑的藥物基因多態(tài)性特點及其在腦梗死患者個體化給藥中的臨床應用價值。方法 選取2018年12月-2019年6月就診中國人民解放軍聯(lián)勤保障部隊第九〇〇醫(yī)院神經(jīng)內(nèi)科的139例急性腦梗死患者，所有患者入院后均口服硫酸氫氯吡格雷片75 mg，1次/d，用藥后均行阿司匹林、氯吡格雷、西洛他唑的藥物基因檢測，結合患者的一般信息對3種藥物基因檢測結果進行統(tǒng)計分析，依據(jù)基因檢測結果和循證醫(yī)學證據(jù)選擇個體化抗血小板聚集藥物治療方案，記錄患者住院期間和出院后90 d使用抗血小板聚集藥物出現(xiàn)的不良反應和臨床療效。結果 在139例患者中，氯吡格雷中代謝、慢代謝的患者有83例，阿司匹林高抵抗的患者有52例，西洛他唑弱代謝型的患者有9例，其中對氯吡格雷抵抗的患者比例最高，達59.71%。合并基礎疾病的患者中，糖尿病為氯吡格雷抵抗的獨立危險因素之一，差異具有統(tǒng)計學意義（P<0.05），而對于阿司匹林、西洛他唑則無統(tǒng)計學差異。對于氯吡格雷抵抗的患者均按基因檢測的結果調(diào)整抗血小板聚集藥物治療方案，所有患者隨訪90 d均未出現(xiàn)新發(fā)的腦血管事件。結論 抗血小板聚集藥物基因多態(tài)性在急性腦梗死患者的治療中具有重要的參考價值。

Objective To study the polymorphisms of aspirin, clopidogrel, and cilostazol, and their clinical application value in individualized administration of patients with cerebral infarction. Methods Patients (139 cases) with acute cerebral infarction in 900 Hospital of the Joint Logistics Support Force of PLA from December 2018 to Jane 2019 were enrolled. Patients were po administered with Clopidogrel Hydrogen Sulfate Tablets, 75 mg/time, once daily. After the drug administration, aspirin, clopidogrel, and cilostazol were detected. The results of the three drug genes were combined with the general information of the patients. Statistical analysis based on genetic testing results and evidence-based medical evidences were used to select individualized antiplatelet regimens, and adverse reactions using antiplatelet agents during hospitalization and 90 d after discharge were recorded. Results In 139 patients, 83 patients had media-metabolic and slow-metabolism in clopidogrel, 52 patients had high aspirin resistance, and 9 patients had cilostazol metabolism, including patients who were resistant to clopidogrel. The proportion was the highest, reaching 59.71%. Diabetes was one of the independent risk factors for clopidogrel resistance, with statistically significant differences (P<0.05). For patients with clopidogrel resistance, antiplatelet regimens were adjusted according to the results of genetic testing. All patients had no cerebrovascular events in 90 d of follow-up. Conclusion Anti-platelet drug gene polymorphism has important reference value in the treatment of patients with acute cerebral infarction.

R971

中國人民解放軍聯(lián)勤保障部隊第九〇〇醫(yī)院院內(nèi)課題（2018Z17）