Clinical Analysis Of Thromboelastogram Parameters Changes And Their Relationship With CYP2C19 Gene Polymorphism In Patients With ASAH

Objective to compare and analyze the changes of TEG parameters in patients with acute aSAH and their relationship with CYP2C19 gene polymorphism and perioperative ischemic complications,and to explore the value of TEG and CYP2C19 gene polymorphism in the treatment of aSAH patients.Methods this study was a retrospective study.From January2018 to July 2019,180 patients with aSAH and 102 patients with UIA were collected from the Department of Neurosurgery of the first affiliated Hospital of Chongqing Medical University.The general clinical data of the patients and the indexes of thromboelastogram(R value(reactiontime),K value(kineticstime),Angle(rateofclotformation),MA value(maximumamplitude),EPL(estimatepercentlysis),LY30(clotlysis),arachidonic acid(arachidonicacid,AA)inhibition rate,adenosine diphosphate(adenosinediphosphate,ADP)inhibition rate,platelet count andblood coagulation)were collected,and the differences of thromboelastogram indexes between aSAH group and UIA group were compared.To explore the correlation between thromboelastogram parameters and general clinical data at admission.According to the presence or absence of perioperative ischemic complications,the patients were divided into two groups:ischemic group(n = 37)and non-ischemic group(n = 222).The general clinical data and thromboelastogram indexes of the two groups were compared.CYP2C19 genotypes were determined in 61 patients.A total of 6 subtypes of CYP2C19*1/*1,CYP2C19*1/*2,CYP2C19*2/*2,CYP2C19*1/*3,C YP2C19*2/*3,CYP2C19*1/*17 were detected in this experiment.Six subtypes of CYP2C19 gene were divided into carrier group and non-carrier group according to whether they carried weak metabolic allele * 2 or * 3.The difference of ADP inhibition rate between the two groups was compared.Results 1.The ADP inhibition rates of R values in TEG parameters of aSAH group and UIA group were4.80,89.80,5.40,57.10 and 33.48,76.68% respectively(P < 0.001),and those of UIA group were 5.40,57.10(33.48,76.68)%,respectively(P < 0.05).The inhibition rates of R values of R values were 4.805.30,89.80(61.95)and 5.40,57.10(33.48,76.68)%in UIA group,respectively(P < 0.05).Among the four items of traditional blood coagulation,the values of PT and INR in aSAH group were 13.40 s and 1.04 s respectively,which were 12.95 s and0.99 in 0.99Pen1.08),UIA group,respectively,which were slightly lower than those in the former group,and the difference was statistically significant(P < 0.001).The APTT of aSAH group was36.45 s shorter than that of UIA group,and the difference was statistically significant(P < 0.001).There was no significant difference in other coagulation related indexes,such as K value,Angle angle,MA value,EPL(estimatepercentlysis),LY30(clotlysis),arachidonic acid(arachidonicacid,AA)inhibition rate,FIb and platelet count(P > 0.001).2.R value was negatively correlated with age(r = 0.124,p = 0.038),and also negatively correlated with Hunt_Hess grade and Fisher grade(r=-0.320,p=0.000/r=-0.257,p=0.000),that is,with the increase of age,clinical symptoms and the amount of intracranial hemorrhage,the activity of coagulation factor was stronger.There were gender differences in the inhibition rate of AA,in which males were higher than females,and the difference was statistically significant(.u=11260.500,p=0.004).The inhibition rate of AA in people with history of smoking and drinking was higher than that of non-smokers and drinkers(u=9726.500,p=0.011/u=8124.500,p=0.032).There was a significant difference in the inhibition rate of ADP between different Hunt_Hess grades/Fisher grade and hematoma after hemorrhage,and the correlation analysis showed a strong positive correlation(r=-0.218,p=0.000/r=0.447,p=0.000/r=0.446,p=0.000).3.There were64 men with hypertension and 48 men with non-hypertension in the ischemia group,compared with 65 men and 105 men with non-hypertension in the non-ischemia group.The proportion of patients with hypertension in the ischemia group was higher than that in the non-ischemia group and there was a statistical difference between the two groups(u=9.725,p=0.002).There was no significant difference in age,sex,location of aneurysm,Hunt_Hess grade,Fisher grade and acute coagulation related indexes between the two groups(P >0.05).4.A total of 61 patients were tested for CYP2C19 genotypes,and CYP2C19*1/*1 、 CYP2C19*1/*2 、 CYP2C19*2/*2 、CYP2C19*1/*3、CYP2C19*2/*3、CYP2C19*1/*17 genotypes were obtained in 16 cases(26.2%),34 cases(55.7%),5 cases(8.2%),4cases(6.6%),1 case(1.6%)and 1 case(1.6%),respectively.Patients with 6 genotypes were divided into carrier group and non-carrier group according to whether they carried weak metabolic allele * 2 or * 3,including 44 cases(72.1%)in carrier group and 17 cases(27.9%)in non-carrier group.There was nosignificant difference in platelet ADP inhibition rate between carrier group and non-carrier group.Conclusions 1.After aSAH,the activity of coagulation factors increased,but the function of platelet aggregation decreased at the same time,and there was a strong correlation between them and Hunt_Hess grade and Fisher grade at the same time.This relationship may counteract the effect of both of them on blood coagulation function.2.Whether the detection of TEG parameters and CYP2C19 genotypes in the acute phase of aSAH can predict perioperative ischemic events or adjust the dosage of clopidogrel in advance after stent-assisted interventional embolization of aneurysmal subarachnoid hemorrhage,further sample size study is needed.