{"title":"血小板对二磷酸腺苷和CYP2C19基因型的反应性与颈动脉斑块有关，并可预测急性缺血性卒中患者颈动脉斑块的稳定性。","authors":"Hongting Shi, Mingzhu Tang, Tiezhu Wang, Lihua Yang, Xuanming Lai, Yongyuan Chen, Fangming Diao, Xiaolian Chen, Jinxi Zuo, Junyang Xu, Gaoxian Zhong, Yaxian Dong","doi":"10.17712/nsj.2025.3.20240104","DOIUrl":null,"url":null,"abstract":"<p><strong>Objectives: </strong>To determine the correlations of ADP-induced platelet-inhibition rate (ADP-PIR) and <i>CYP2C19</i> genotypes with carotid plaque types in acute ischemic stroke (AIS). Unstable carotid plaques are implicated in AIS. Clopidogrel (commonly prescribed in AIS) produces adenosine diphosphate (ADP)-induced platelet inhibition, and is metabolized by <i>CYP2C19</i>.</p><p><strong>Methods: </strong>We retrospectively evaluated the data of AIS patients treated at our hospital during 2019-2022, and administered maintenance clopidogrel (75 mg/d). Carotid plaques, ADP-PIR, and <i>CYP2C19</i> genotypes were assessed using color Doppler ultrasonography, thromboelastography, and polymerase chain reaction assays, respectively. Multivariate logistic regression and receiver operating characteristic (ROC) curve analyses were conducted.</p><p><strong>Results: </strong>Of 692 study patients, 378 (54.6%) and 128 (18.5%) had unstable and stable carotid plaques, respectively. Multivariate logistic regression identified PIR and <i>CYP2C19</i> genotype as independent risk factors for stable carotid plaque (PIR, OR: 0.984, 95% CI: 0.974-0.995, <i>p</i>=0.003; intermediate metabolizer, OR: 0.158, 95% CI: 0.066-0.379, <i>p</i><0.001; poor metabolizer, OR: 0.584, 95% CI: 0.155-2.206, <i>p</i>=0.428) and unstable carotid plaque (PIR, OR: 0.957, 95% CI: 0.949-0.966, <i>p</i><0.001; intermediate metabolizer, OR: 0.151, 95% CI: 0.063-0.362, <i>p</i><0.001; poor metabolizer, OR: 0.145, 95% CI: 0.051-0.416, <i>p</i><0.001). Areas under the ROC curve for predicting unstable and stable carotid plaques were 0.700 (PIR) and 0.716 (<i>CYP2C19</i> genotype), and 0.631 (PIR) and 0.650 (<i>CYP2C19</i> genotype), respectively.</p><p><strong>Conclusion: </strong>The PIR and <i>CYP2C19</i> genotype are correlated with and may predict carotid plaque types in AIS.</p>","PeriodicalId":19284,"journal":{"name":"Neurosciences","volume":"30 3","pages":"226-236"},"PeriodicalIF":1.3000,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12279339/pdf/","citationCount":"0","resultStr":"{\"title\":\"Platelet reactivity to adenosine diphosphate and <i>CYP2C19</i> genotypes are linked with carotid plaques and may predict carotid plaque stability in acute ischemic stroke patients.\",\"authors\":\"Hongting Shi, Mingzhu Tang, Tiezhu Wang, Lihua Yang, Xuanming Lai, Yongyuan Chen, Fangming Diao, Xiaolian Chen, Jinxi Zuo, Junyang Xu, Gaoxian Zhong, Yaxian Dong\",\"doi\":\"10.17712/nsj.2025.3.20240104\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objectives: </strong>To determine the correlations of ADP-induced platelet-inhibition rate (ADP-PIR) and <i>CYP2C19</i> genotypes with carotid plaque types in acute ischemic stroke (AIS). Unstable carotid plaques are implicated in AIS. Clopidogrel (commonly prescribed in AIS) produces adenosine diphosphate (ADP)-induced platelet inhibition, and is metabolized by <i>CYP2C19</i>.</p><p><strong>Methods: </strong>We retrospectively evaluated the data of AIS patients treated at our hospital during 2019-2022, and administered maintenance clopidogrel (75 mg/d). Carotid plaques, ADP-PIR, and <i>CYP2C19</i> genotypes were assessed using color Doppler ultrasonography, thromboelastography, and polymerase chain reaction assays, respectively. Multivariate logistic regression and receiver operating characteristic (ROC) curve analyses were conducted.</p><p><strong>Results: </strong>Of 692 study patients, 378 (54.6%) and 128 (18.5%) had unstable and stable carotid plaques, respectively. Multivariate logistic regression identified PIR and <i>CYP2C19</i> genotype as independent risk factors for stable carotid plaque (PIR, OR: 0.984, 95% CI: 0.974-0.995, <i>p</i>=0.003; intermediate metabolizer, OR: 0.158, 95% CI: 0.066-0.379, <i>p</i><0.001; poor metabolizer, OR: 0.584, 95% CI: 0.155-2.206, <i>p</i>=0.428) and unstable carotid plaque (PIR, OR: 0.957, 95% CI: 0.949-0.966, <i>p</i><0.001; intermediate metabolizer, OR: 0.151, 95% CI: 0.063-0.362, <i>p</i><0.001; poor metabolizer, OR: 0.145, 95% CI: 0.051-0.416, <i>p</i><0.001). Areas under the ROC curve for predicting unstable and stable carotid plaques were 0.700 (PIR) and 0.716 (<i>CYP2C19</i> genotype), and 0.631 (PIR) and 0.650 (<i>CYP2C19</i> genotype), respectively.</p><p><strong>Conclusion: </strong>The PIR and <i>CYP2C19</i> genotype are correlated with and may predict carotid plaque types in AIS.</p>\",\"PeriodicalId\":19284,\"journal\":{\"name\":\"Neurosciences\",\"volume\":\"30 3\",\"pages\":\"226-236\"},\"PeriodicalIF\":1.3000,\"publicationDate\":\"2025-07-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12279339/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Neurosciences\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.17712/nsj.2025.3.20240104\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q4\",\"JCRName\":\"CLINICAL NEUROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Neurosciences","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.17712/nsj.2025.3.20240104","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
Platelet reactivity to adenosine diphosphate and CYP2C19 genotypes are linked with carotid plaques and may predict carotid plaque stability in acute ischemic stroke patients.
Objectives: To determine the correlations of ADP-induced platelet-inhibition rate (ADP-PIR) and CYP2C19 genotypes with carotid plaque types in acute ischemic stroke (AIS). Unstable carotid plaques are implicated in AIS. Clopidogrel (commonly prescribed in AIS) produces adenosine diphosphate (ADP)-induced platelet inhibition, and is metabolized by CYP2C19.
Methods: We retrospectively evaluated the data of AIS patients treated at our hospital during 2019-2022, and administered maintenance clopidogrel (75 mg/d). Carotid plaques, ADP-PIR, and CYP2C19 genotypes were assessed using color Doppler ultrasonography, thromboelastography, and polymerase chain reaction assays, respectively. Multivariate logistic regression and receiver operating characteristic (ROC) curve analyses were conducted.
Results: Of 692 study patients, 378 (54.6%) and 128 (18.5%) had unstable and stable carotid plaques, respectively. Multivariate logistic regression identified PIR and CYP2C19 genotype as independent risk factors for stable carotid plaque (PIR, OR: 0.984, 95% CI: 0.974-0.995, p=0.003; intermediate metabolizer, OR: 0.158, 95% CI: 0.066-0.379, p<0.001; poor metabolizer, OR: 0.584, 95% CI: 0.155-2.206, p=0.428) and unstable carotid plaque (PIR, OR: 0.957, 95% CI: 0.949-0.966, p<0.001; intermediate metabolizer, OR: 0.151, 95% CI: 0.063-0.362, p<0.001; poor metabolizer, OR: 0.145, 95% CI: 0.051-0.416, p<0.001). Areas under the ROC curve for predicting unstable and stable carotid plaques were 0.700 (PIR) and 0.716 (CYP2C19 genotype), and 0.631 (PIR) and 0.650 (CYP2C19 genotype), respectively.
Conclusion: The PIR and CYP2C19 genotype are correlated with and may predict carotid plaque types in AIS.
期刊介绍：
Neurosciences is an open access, peer-reviewed, quarterly publication. Authors are invited to submit for publication articles reporting original work related to the nervous system, e.g., neurology, neurophysiology, neuroradiology, neurosurgery, neurorehabilitation, neurooncology, neuropsychiatry, and neurogenetics, etc. Basic research withclear clinical implications will also be considered. Review articles of current interest and high standard are welcomed for consideration. Prospective workshould not be backdated. There are also sections for Case Reports, Brief Communication, Correspondence, and medical news items. To promote continuous education, training, and learning, we include Clinical Images and MCQ’s. Highlights of international and regional meetings of interest, and specialized supplements will also be considered. All submissions must conform to the Uniform Requirements.
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