Research On The Rapid Detection Of CYP2C19 Gene To Guide HR-NICE Individualized Antiplatelet Therapy

Objective: Based on the results of the rapid detection of CYP2C19 gene,this study provides individualized antiplatelet therapy for high-risk nondisabling ischemic cerebrovascular events,and compares the clinical efficacy and safety after 3 months with the conventional treatment group,and further explores the clinical significance of rapid CYP2C19 gene detection.Methods1.Adopting a prospective approach to enroll HR-NICE patients who were admitted to the department of neurology,Chenzhou First People’s Hospital from August 2019 to December 2020.2.The patients were divided into individualized treatment group(plan A and plan B)and a conventional treatment group(plan C)using a random number table method.The individualized treatment groupundergoes rapid CYP2C19 gene detection before treatment.According to its genotype,it is divided into rapid metabolizer(EM),intermediate metabolizer(IM),poor metabolizer(PM),and ultrarapid metabolizer(UM).Different treatment plans are given based on genotype,which can be divided into plan A(EM)and plan B(UM,IM,PM).Plan A: Aspirin combined with clopidogrel;Plan B: Aspirin;Plan C: Same as Plan A.3.Follow-up for 3 months,record and compares the three’s clinical endpoints(efficacy indicators and safety endpoints).Results1.A total of 107 patients in this study completed the full trial protocol.The general conditions of the included patients were collected,and the results showed that there was no statistically significant difference in general conditions between the three(P>0.05).2.A total of 57 patients were included in the individualized treatment group(Plan A and Plan B),and the number of patients carrying CYP2C19 mutant alleles(*2,*3,*17)was 28(50.8%)cases.3.After 3 months of follow-up,there were 1(3.6%)cases in the plan A,1(3.4%)in the plan B,and 6(12.0%)in the plan C that reached the primary efficacy endpoint(any new stroke event).There was no statistically significant difference between the three(P>0.05).In the secondary efficacy endpoint,the incidence of new vascular events in the three was significantly different(P=0.035).Pairwise comparison showed that the incidence of plan B was significantly lower than that of plan C(P=0.048);The m RS scores of the three after 3 months were divided into good(scoring 0-1 points)and bad(scoring2-6 points),and the difference was not statistically significant(P>0.05).There was no significant difference in the number of safety events(severe bleeding or moderate bleeding)among the three(P>0.05).4.Univariate factors affecting whether new vascular events in patients 3months after logistic regression analysis.The m RS score(m RS score value)at admission may affect the 3-month new vascular event(P=0.001,OR=3.69,95%CI 1.658,8.212).The higher the admission m RS score,the 3-month new vascular event the higher the risk.Conclusions1.Individualized antiplatelet therapy carrying the CYP2C19 mutant gene can significantly reduce the incidence of new vascular events after 3months of high-risk nondisabling ischemic cerebrovascular events.2.The m RS score at admission is an influencing factor for new vascular events in high-risk nondisabling ischemic cerebrovascular events 3 months later.