Liu Guohua, Yang Sufang, Chen Siqia
Department of Pharmacy.
Department of Neurology, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China.
Medicine (Baltimore). 2020 Mar;99(11):e19143. doi: 10.1097/MD.0000000000019143.
To explore the correlation between recurrent risk and CYP2C19 gene polymorphisms in patients with ischemic stroke (IS) treated with clopidogrel for prevention.
A total of 289 patients with IS treated with clopidogrel regularly were enrolled in this study, and stroke recurrence of all patients were recorded by follow-up. The correlation between CYP2C19 gene polymorphism and stroke recurrence in patients taking clopidogrel regularly was analyzed.
After a mean follow-up period of 6 months, there were 289 patients who took clopidogrel regularly, and 41 of which occurred recurrent stroke. Patients of poor metabolizer and intermediate metabolizer had higher risk of recurrent stroke comparing with patients of extensive metabolize, and the odds ratios were 2.88 (95% confidence interval [CI] 1.31-6.33, P = .068) and 3.00 (95% CI 1.09-8.22, P = .027), respectively. The recurrence risk of *2 (G681A)A allele carriers was 3.30 times that of G allele carriers (P = .0065). The recurrence rate of stroke in patients carrying heterozygous and homozygous *2 allele mutant was 1.96 times (P = .071) and 3.30 times (P = .012) that of patients with wild-type genes. Multifactor logistic regression analysis result indicated carrying loss of function (LOF) allele was an independent risk factor of stroke recurrence.
For patients with IS treated with clopidogrel regularly for secondary prevention, poor metabolizer, and intermediate metabolizer patients had higher risk of recurrent stroke comparing with extensive metabolize ones. Carrying CYP2C19 LOF allele is an independent risk factor of stroke recurrence in patients with IS.
探讨接受氯吡格雷治疗以预防缺血性卒中（IS）患者的复发风险与CYP2C19基因多态性之间的相关性。
本研究共纳入289例规律服用氯吡格雷的IS患者，通过随访记录所有患者的卒中复发情况。分析规律服用氯吡格雷患者的CYP2C19基因多态性与卒中复发之间的相关性。
平均随访6个月后，289例规律服用氯吡格雷的患者中，有41例发生卒中复发。与快代谢型患者相比，慢代谢型和中间代谢型患者的卒中复发风险更高，比值比分别为2.88（95%置信区间[CI] 1.31 - 6.33，P = 0.068）和3.00（95% CI 1.09 - 8.22，P = 0.027）。2（G681A）A等位基因携带者的复发风险是G等位基因携带者的3.30倍（P = 0.0065）。携带杂合子和纯合子2等位基因突变患者的卒中复发率分别是野生型基因患者的1.96倍（P = 0.071）和3.30倍（P = 0.012）。多因素logistic回归分析结果表明，携带功能缺失（LOF）等位基因是卒中复发的独立危险因素。
对于接受氯吡格雷规律治疗进行二级预防的IS患者，慢代谢型和中间代谢型患者比快代谢型患者有更高的卒中复发风险。携带CYP2C19 LOF等位基因是IS患者卒中复发的独立危险因素。
