| 72h内SAO患者基于CYP2C19基因快检双重抗血小板治疗的临床分析 |
| 投稿时间：2025-03-07 修订日期：2025-03-12 点此下载全文 |
| 引用本文：倪慧,陈国芳,刘薇薇,徐辉,王琛,耿耿,韦家南,何忠伟.72h内SAO患者基于CYP2C19基因快检双重抗血小板治疗的临床分析[J].医学研究杂志,2025,54(9):142-146, 163 |
| DOI：
10.11969/j.issn.1673-548X.2025.09.024 |
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| 基金项目:江苏省徐州市医学领军人才培养项目(XWRCHT20210037) |
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| 中文摘要:目的 探讨在细胞色素P450 2C19(cytochrome P450 2C19, CYP2C19)基因快检的精准指导下,不携带CYP2C19功能缺失(loss-of-function allele, LOF)等位基因的小动脉闭塞型脑梗死(small artery occlusion, SAO)患者在发病72h内进行双重抗血小板治疗的有效性与安全性。方法 回顾性收集2023年1~12月在徐州市中心医院神经内科就诊的不携带CYP2C19-LOF等位基因且发病72h内的SAO患者,将患者分为两组:对照组和试验组。对照组采用阿司匹林单药治疗,试验组采用阿司匹林联合氯吡格雷双重抗血小板治疗。收集两组患者的基线资料,记录治疗第1、7、21、90天内的改良Rankin量表(modified Rankin scale, mRS)评分及美国国立卫生研究院脑卒中量表(National Institutes of Health Stroke Scale, NIHSS)、不良事件的发生情况等。主要有效结局为90天内发生新发脑卒中,主要安全结局为90天内出现中重度出血。结果 共收集患者130例,对照组61例,试验组69例。其中试验组中脑卒中发作不超过24h者占11.6%,24~48h者占47.8%,48~72h者占40.6％。两组患者基线资料比较,差异均无统计学意义(P>0.05)；两组90天新发脑卒中对照组9例(14.8%),试验组3例(4.3%),差异有统计学意义(χ2=4.185,P<0.05)；两组90天中重度出血对照组0例,试验组1例(1.4%),两组比较差异无统计学意义(P>0.05)。结论对于发病72h内的非CYP2C19-LOF的SAO患者,阿司匹林联合氯吡格雷的双重抗血小板治疗能够有效减少患者脑卒中复发,同时两者在安全性上表现一致,未观察到联合用药导致更多的出血等不良事件发生。 |
| 中文关键词:小动脉闭塞型脑梗死 CYP2C19 氯吡格雷 双重抗血小板治疗 治疗时间窗 快速基因检测 |
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| Clinical Analysis of Dual Antiplatelet Therapy Based on CYP2C19 Gene Rapid Test in SAO Patients within 72 Hours |
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| Abstract:Objective To investigate the efficacy and safety of dual antiplatelet therapy within 72hours of onset in patients with small artery occlusion (SAO) who do not carry the cytochrome P450 2C19 (CYP2C19) loss-of-function (LOF) allele, under the precise guidance of rapid testing for the CYP2C19gene. Methods A retrospective study was conducted to collect patients with stroke of SAO who presented within 72hours of onset and did not carry the CYP2C19 LOF allele, attending the Department of Neurology, Xuzhou Central Hospital between January and December 2023. Patients were divided into two groups:the control group and the experimental group, the control group received aspirin monotherapy, and the experimental group received dual antiplatelet therapy with aspirin and clopidogrel. Baseline characteristics of both groups were collected, and the modified Rankin scale (mRS) scores and National Institutes of Health Stroke Scale (NIHSS) scores were recorded on the 1st, 7th, 21st and 90th days of treatment. Additionally, the occurrence of adverse events was documented. The primary efficacy outcome was the incidence of new stroke within 90 days, while the primary safety outcome was the occurrence of moderate-to-severe bleeding within 90days. Results A total of 130 patients were enrolled in the study, with 61 patients in the control group, and 69 patients in the experimental group. Within the experimental group, patients with stroke onset within 24 hours accounted for 11.6%, those with onset between 24 and 48 hours accounted for 47.8%, and those with onset between 48 and 72 hours accounted for 40.6%. There were no statistically significant differences in baseline characteristics between the two groups (P>0.05). Regarding new strokes within 90days, there were 9 cases (14.8%) in the control group, and 3 cases (4.3%) in the experimental group, with a statistically significant difference (χ2=4.185, P<0.05). For moderate-to-severe bleeding within 90days, there were 0 cases in the control group, and 1 case (1.4%) in the experimental group, there was no statistically significant difference between the two groups (P>0.05). Conclusion For patients with stroke of SAO who are non-carriers of CYP2C19 LOF allele and have onset within 72 hours, dual antiplatelet therapy with aspirin combined with clopidogrel can effectively reduce the recurrence of stroke. Additionally, the two drugs demonstrate consistent safety profiles, with no observed increase in adverse events such as bleeding associated with the combination therapy. |
| keywords:Small artery occlusion CYP2C19 Clopidogrel Dual antiplatelet therapy Treatment time window Rapid genetic testing |
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