Jeong Tae-Dong, Kim Seung Min, Kim Hyo Jin, Lee Woochang, Kwon Sun U, Min Won-Ki, Kang Dong-Wha, Chun Sail
Department of Laboratory Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
Department of Neurology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
J Stroke Cerebrovasc Dis. 2015 Feb;24(2):440-6. doi: 10.1016/j.jstrokecerebrovasdis.2014.09.014. Epub 2014 Dec 17.
Early recurrent ischemic lesions detected on diffusion-weighted imaging (DWI) have been proposed as a surrogate marker for clinical recurrence. We hypothesized that cytochrome P450 2C19 (CYP2C19) genotype influences the incidence of early recurrence on DWI in acute stroke patients treated with clopidogrel.
We enrolled 76 Korean patients with acute ischemic stroke due to large artery atherosclerosis who were treated with clopidogrel. Early ischemic lesion recurrence was defined as new lesions separate from the index lesion. We compared the rates of early ischemic lesion recurrence on DWI based on the CYP2C19 genotypes.
Early recurrence on DWI was observed in 36 patients (47.4%). A total of 76 patients were classified into 3 phenotypic groups: extensive metabolizers (EMs; n = 27, 35.5%), intermediate metabolizers (IMs; n = 36, 47.4%), and poor metabolizers (PMs; n = 13, 17.1%). Early recurrence on DWI was more common in PMs (84.6%), followed by IMs (50.0%), and EMs (25.9%; P < .001). PMs had a significantly higher recurrence rate than EMs (P < .001). In multivariate analysis, CYP2C19 genotypes were independently associated with early DWI recurrence (for PMs: odds ratio, 19.3; 95% confidence interval, 3.15-117.56).
CYP2C19 genotypes are significantly associated with early lesion recurrence in Korean acute stroke patients treated with clopidogrel.
弥散加权成像（DWI）检测到的早期复发性缺血性病变已被提议作为临床复发的替代标志物。我们假设细胞色素P450 2C19（CYP2C19）基因型会影响接受氯吡格雷治疗的急性卒中患者DWI早期复发的发生率。
我们纳入了76例因大动脉粥样硬化导致急性缺血性卒中且接受氯吡格雷治疗的韩国患者。早期缺血性病变复发定义为与索引病变分离的新病变。我们比较了基于CYP2C19基因型的DWI早期缺血性病变复发率。
36例患者（47.4%）出现DWI早期复发。76例患者共分为3个表型组：快代谢型（EMs；n = 27，35.5%）、中代谢型（IMs；n = 36，47.4%）和慢代谢型（PMs；n = 13，17.1%）。DWI早期复发在PMs中更为常见（84.6%），其次是IMs（50.0%）和EMs（25.9%；P <.001）。PMs的复发率显著高于EMs（P <.001）。在多变量分析中，CYP2C19基因型与DWI早期复发独立相关（对于PMs：比值比，19.3；95%置信区间，3.15 - 117.56）。
CYP2C19基因型与接受氯吡格雷治疗的韩国急性卒中患者早期病变复发显著相关。
