接受血管内治疗患者的 CYP2C19 基因多态性与预后之间的关系

Wei Li, Xun Yang, Jing Chen, Jian-Wei Zhu, Ling-Huan Zeng, Hai-Hong Long, Zhi Chen, Jun Tang, Xiao-Fang Lan
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摘要

细胞色素 P450 2c19(CYP2C19)多态性对接受血管内治疗的患者的预后有潜在的重大影响。为了改善预后并降低复发率,本研究对急性缺血性卒中患者的 CYP2C19 多态性进行了调查。 研究对2017年5月至2019年5月期间在重庆市中医院神经内科接受急性血管内再通治疗的292例脑梗死患者进行了回顾性分析。根据CYP2C19基因多态性将患者分为快代谢组、中代谢组和慢代谢组,并对其预后进行监测。此外,还观察了在选定时间选择性接受颈动脉支架植入术的 188 名患者的预后情况。 在接受急性血管内再通术的292例脑梗死病例中,CYP2C19快速代谢组患者定期服用氯吡格雷和阿司匹林联合抗血小板治疗,再发脑梗死和脑出血;90天良好预后有统计学差异(P<0.05,预后评估包括住院和出院后6个月),其他不良事件无统计学差异(包括死亡率)。选择性接受颈动脉支架置入术的188例患者中,中风复发率、脑出血率和再狭窄率有统计学差异(P<0.05),其他不良事件无统计学差异。 总之,本研究结果表明,无论患者是接受选择性颈动脉支架植入术还是急性血管内再狭窄术,CYP2C19代谢快的患者发生不良预后事件的可能性明显低于代谢中等和慢的患者。此外,这组患者的预后也比其他两组患者更佳。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
The Association Between CYP2C19 Genetic Polymorphism and Prognosis in Patients Receiving Endovascular Therapy
Potentially substantial impacts on the prognosis have been observed in individuals undergoing endovascular treatment due to cytochrome P450 2c19 (CYP2C19) polymorphism. In an attempt to improve prognosis and lower the recurrence rate, this study investigated the CYP2C19 polymorphism in acute ischemic stroke patients. A retrospective analysis was performed on 292 patients with cerebral infarction who had acute endovascular recanalization at the Department of Neurology of Chongqing Hospital of Traditional Chinese Medicine between May 2017 and 2019. The patients were categorized into rapid-, medium-, and slow-metabolism groups based on CYP2C19 gene polymorphism, and their prognosis was monitored. In addition, the prognosis of 188 patients selectively receiving carotid artery stenting at a selected time was also observed. Among the 292 cerebral infarction cases receiving acute endovascular recanalization, the patients in the CYP2C19 rapid-metabolism group regularly took clopidogrel and aspirin combined with antiplatelet therapy and suffered from reoccurrence of apoplexy and cerebral hemorrhage; the 90-day good prognosis had a statistical difference (P < 0.05, prognostic assessment includes hospitalization and 6 months after discharge) and the other adverse events had no statistical difference (including mortality). The 188 patients selectively receiving carotid artery stenting had a recurrence of apoplexy, cerebral hemorrhage, and restenosis rate with a statistical difference (P < 0.05), and the other adverse events had no statistical difference. In conclusion, the findings of the current study indicate that irrespective of whether patients are undergoing selective carotid artery stenting or acute endovascular recanalization, those with rapid CYP2C19 metabolism have a significantly lower likelihood of experiencing adverse prognostic events compared to those with intermediate and slow metabolism. Furthermore, this group also has a more favorable prognosis than the other two groups.
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