| 余芬.缺血性卒中病人CYP2C19基因多态性与个体化抗血小板治疗的临床观察[J].安徽医药,2017,21(4):724-727. |
| 缺血性卒中病人CYP2C19基因多态性与个体化抗血小板治疗的临床观察 |
| Clinical study of CYP2C19 polymorphisms and individual antiplatelettherapy in patients with ischemic stroke |
| 投稿时间：2016-11-16 |
| DOI： |
| 中文关键词: 缺血性卒中 CYP2C19 个体化 抗血小板治疗 |
| 英文关键词: Ischemic stroke CYP2C19 Individualized Antiplatelet therapy |
| 基金项目:武汉市卫生与计划生育委员会科研项目(WX15C12)缺血性卒中病人CYP2C19基因多态性与个体化抗血小板治疗的临床观察余芬 (武汉市第三医院神经内科,湖北 武汉 430060)缺血性卒中病人CYP2C19基因多态性与个体化抗血小板治疗的临床观察 余芬 Clinical study of CYP2C19 polymorphisms and individual antiplatelet therapy in patients with ischemic stroke YU Fen |
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| 中文摘要: |
| 目的 研究小样本缺血性卒中病人的CYP2C19基因型,根据其CYP2C19基因型指导个体化抗血小板治疗并观察其临床预后。方法 入选急性缺血卒中病人300例,对入选病人采用随机数字表法分为个体化治疗组150例和常规治疗组150例。个体化治疗组在入选后立即检测CYP2C19基因,按照不同的基因型采用个体化的抗血小板治疗方案,即快代谢型按照氯吡格雷负荷量300 mg、维持量50 mg·d-1口服；中间代谢型按照氯吡格雷负荷量300 mg、维持量75 mg·d-1口服；慢代谢型按照氯吡格雷负荷量300 mg、维持量75 mg·d-1,联合阿司匹林100 mg·d-1口服。常规治疗组直接按照氯吡格雷负荷量300 mg、维持量75 mg·d-1口服治疗,不检测CYP2C19基因。通过随访观察两组病人治疗30 d及180 d不良事件发生率之间的差异。结果 随访6个月,再发缺血性卒中的发生率在个体化治疗组显著降低(P<0.05),出血事件的发生率在个体化治疗组明显低于常规治疗组(P<0.05)。结论 根据CYP2C19基因型采取不同的治疗方案可以及时发现慢代谢病人,进而调整抗血小板聚集治疗方案,降低不良事件发生率并可以减少药物的不良反应。 |
| 英文摘要: |
| Objective To explore the method of the individualized antiplatelet therapy and its effect of clinical prognosis by researching CYP2C19 genotype in patients with ischemic stroke.Methods The 300 patients with acute ischemic stroke were randomly assigned into the individual treatment group (n=150) and the conventional treatment group (n=150).In the individual treatment group,the CYP2C19 genotype was detected immediately before treatment with antiplatelet therapy.According to the different genotypes,the different antiplatelet treatment regimens were used.The patients with fast metabolizer were given clopidogrel 300 mg loading dose,maintenance dose clopidogrel 50 mg·d-1；intermediate metabolizers were given clopidogrel 300 mg loading dose,maintenance dose clopidogrel 75 mg·d-1；slow metabolizers were given clopidogrel 300 mg loading dose,maintenance dose clopidogrel 75 mg·d-1 plus aspirin 100 mg·d-1.The conventional treatment group was not detected the CYP2C19 genotype and was treated with conventional clopidogrel therapy (loading dose 300 mg,maintenance dose 75 mg·d-1).The differences in adverse events between these two groups were observed 30 days and 180 days after ischemic stroke.Results After 180 d follow-up,the incidence of recurrent ischemic stroke in the individual treatment group was lower than that in the conventional group(P<0.05).The incidence of bleeding events in the individual treatment group was obviously lower than that in the conventional group (P<0.05).Conclusions To take different treatment regimens according to CYP2C19 genotype can find the slow metabolizers in time,and then adjust the antiplatelet aggregation therapy,significantly reduce the incidence of adverse events and reduce the adverse drug reactions. |
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