陈建秋　章颖　胡彬彬

[摘要] 目的 探讨CYP2C19基因多态性对氯吡格雷治疗急性脑梗死的疗效影响。 方法 选取2015年12月～2016年12月我院收治的210例急性腦梗死患者，所有患者均给予氯吡格雷进行治疗2周，根据CYP2C19基因型分析结果，将其分为快代谢组（n=61）、中代谢组（n=121）和慢代谢组（n=28），计算服药前及服药后1 d、5 d各组的血小板聚集抑制率并进行分析，并于服药前及服药后7 d、14 d进行NIHSS和日常生活活动能力评价（ADL）评分，同时采用多元素Logistic回归分析法分析影响血小板聚集抑制率的因素。 结果 各组服药后1 d、5 d血小板聚集抑制率均较服药前显著降低（P<0.05），但快代谢组服药后1 d、5 d血小板聚集抑制率显著低于中代谢组和慢代谢组（P<0.05）。各组服药后7 d、14 d NIHSS评分均较服药前显著降低（P<0.05），ADL评分均较服药前升高，但快代谢组服药后7 d、14 d NIHSS评分显著低于中代谢组和慢代谢组（P<0.05），ADL评分显著性高于中代谢组和慢代谢组（P<0.05）。对年龄、性别、吸烟、饮酒、体重指数、高血压、糖尿病、高脂血症、CYP2C19基因多态性进行多因素Logistic回归分析，结果显示CYP2C19基因多态性是影响氯吡格雷血小板聚集抑制率的影响因素（P<0.05）。结论 CYP2C19 基因多态性可影响氯吡格雷的临床疗效，其中携带有等位基因*2和/（或）*3对氯吡格雷疗效有负面的影响。

[关键词] CYP2C19基因多态性；氯吡格雷；急性脑梗死；疗效

[中图分类号] R743.3 [文献标识码] A [文章编号] 1673-9701（2017）23-0006-04

[Abstract] Objective To investigate the curative effects of CYP2C19 gene polymorphism on clopidogrel in the treatment of acute cerebral infarction. Methods From December 2015 to December 2016 in our hospital，210 cases of patients with acute cerebral infarction having 2 weeks of clopidogrel treatment were chosen and divided into the fast metabolism group （n=61）， the middle metabolism group （n=121） and the slow metabolism group （n=28）. Before treatment and 1 d， 5 d after treatment， according to the CYP2C19 genotype analysis results， the inhibition of platelet aggregation and analysis， evaluation of NIHSS and the activities of daily life （ADL） were recorded and compared； Logistic multi element regression analysis method were used to analyze blood agglutination inhibition rate. Results 1 d and 5 d after taking medicine， the inhibition rates of platelet aggregation in all groups were significantly lower than that before the treatment（P<0.05）， which in the fast metabolism group was lower than that in the middle metabolism group and the slow metabolism group（P<0.05）. 7 d， 14 d after treatment， NIHSS scores were significantly lower than those before treatment（P<0.05）， ADL scores were increased compared with before taking medicine，but sooner after taking medicine. 7 d， 14 d in the fast metabolism group NIHSS score was significantly lower than that in the middle metabolism group and the slow metabolism group（P<0.05）； While ADL score was significantly higher than that in the middle metabolism group and the slow metabolism group（P<0.05）. The logistic regression analysis ressults of age， sex， smoking， drinking， BMI， hypertension，diabetes，hyperlipidemia and CYP2C19 gene polymorphism showed that CYP2C19 gene polymorphism was the influencing factors of clopidogrel platelet aggregation inhibition rate（P<0.05）. Conclusion Polymorphisms in the CYP2C19 gene could affect the clinical efficacy of clopidogrel， with allele *2 and/or *3 having a negative effect on clopidogrel efficacy.endprint

[Key words] CYP2C19 gene polymorphism； Clopidogrel； Acute cerebral infarction； Curative effect

急性脑梗死是常见的急性脑血管疾病，具有发病率高、致残率高、死亡率高及复发率高的特点，使其成为临床工作中最为棘手的问题之一，给家庭和社会带来严重的负担[1]。中国急性缺血性脑卒中诊治指南推荐[2]：对不能进行溶栓治疗的患者应尽早开始抗血小板治疗；而应用溶栓治疗的患者，在溶栓治疗 24 h后如无出血等禁忌证，亦应尽早开始抗血小板治疗，这就使得抗血小板治疗成为神经病学界在脑血管病治疗研究中的另一热点。氯吡格雷是临床上常用的抗血小板药物，某些患者经过标准氯吡格雷治疗后，仍不能避免缺血性事件的发生，被称之为氯吡格雷抵抗。其原因可能是因为氯吡格雷是一种前体药物，本身并无抗血小板作用，服药吸收后需要在……