目的 基于CYP2C19基因多態(tài)性探究氯吡格雷聯(lián)合依達拉奉對急性腦梗死患者神經(jīng)功能的影響。方法 通過真實世界研究,于2019年1月-2020年7月在東莞市人民醫(yī)院收集氯吡格雷聯(lián)合依達拉奉注射液治療的急性腦梗死患者。采用實時熒光定量PCR法檢測患者的CYP2C19基因型,根據(jù)基因型將患者分為快代謝型組、中間代謝型組和慢代謝型組。通過神經(jīng)功能損傷評分量表(NIHSS)評價患者急性腦梗死的神經(jīng)功能。結(jié)果 270例急性腦梗死患者中快代謝型(CYP2C19*1/*1)患者102例,占37.78%;中間代謝型(CYP2C19*1/*2、CYP2C19*1/*3、CYP2C19*2/*17、CYP2C19*3/*17)患者140例,占51.85%;慢代謝型(CYP2C19*2/*2、CYP2C19*3/*3、CYP2C19*2/*3)患者28例,占10.37%?？齑x型、中間代謝型患者治療后的NIHSS評分顯著降低,差異有統(tǒng)計學意義(P<0.05)。慢代謝型沒有統(tǒng)計學意義。進一步分析發(fā)現(xiàn),與慢代謝型患者相比,快代謝型、中間代謝型患者治療前后的NIHSS評分顯著下降,差值有統(tǒng)計學意義(P<0.05)。結(jié)論 CYP2C19基因多態(tài)性在氯吡格雷聯(lián)合依達拉奉治療急性腦梗死患者的神經(jīng)功能影響具有差異。快代謝型和中間代謝型患者神經(jīng)功能顯著改善,慢代謝型患者沒有顯著性差異,建議結(jié)合臨床情況,及時調(diào)整治療方案。

Objective To explore the neurological function of CYP2C19 gene polymorphism in clopidogrel combined with edaravone in treatment of patients with acute cerebral infarction.Methods Patients with acute cerebral infarction in Dongguan People's Hospital treated with clopidogrel combined with edaravone were collected from January 2019 to July 2020 in a real-world study. The CYP2C19 genotype of the patients was detected by Real-time Fluorescence Quantitative PCR, and the patients were divided into extensive metabolizers group, intermediate metabolizer group, and poor metabolizer group according to the genotype. The neurological function of acute cerebral infarction was evaluated by National Institutes of Health Stroke Scale (NIHSS).Results A total of 270 patients with acute cerebral infarction treated with clopidogrel combined with edaravone injection were collected, of which 102 patients with extensive metabolizers group (CYP2C19*1/*1) accounted for 37.78%. There were 140 patients with intermediate metabolizer group (CYP2C19*1/*2, CYP2C19*1/*3, CYP2C19*2/*17, and CYP2C19*3/*17), accounting for 51.85%. There were 28 patients with poor metabolizer group (CYP2C19*2/*2, CYP2C19*3/*3, and CYP2C19*2/*3), accounting for 10.37%. The NIHSS scores of patients in extensive metabolizers and intermediate metabolizer treated with clopidogrel combined with edaravone were significantly decreased, and the difference were statistically significant (P < 0.05). Poor metabolizer group was not statistically significant. Compared with patients in poor metabolizer group, NIHSS scores of patients in extensive metabolizers and intermediate metabolizer group were decreased, with statistical significance (P < 0.05).Conclusion The effect of CYP2C19 gene polymorphisms on neurological function in patients with acute cerebral infarction treated with clopidogrel combined with edaravone is different. The neurological function of patients with extensive metabolizers and intermediate metabolizer were significantly decreased, and there was no significant difference in patients with poor metabolizer group. It is recommended to adjust the treatment plan in time according to the clinical situation.

R971

廣東省醫(yī)學科學技術(shù)研究基金項目(B2020086);廣東省醫(yī)院藥學研究基金(澳美基金)資助項目(2021A08)