| Objective:The study is aimed at analyzing the relationship between Clopidogrel Resistance(CR)and CYP2C19 gene polymorphism in sufferers with Correlation Ischemic Stroke(CIS)through detecting gene and determining blood platelet function,so as to provide equitable and to advantage treatment for sufferers with CIS.Methods:1.142 sufferers with CIS who met the inclusion criteria were selected from the First Affiliated Hospital of Hebei North University from March 2020 to December 2020.2.Collecting base data of all sufferers,mainly including gender,age,bad habits(smoking,drinking),past or after admission diagnosis(hypertension,hyperlipidemia,diabetes).3.All sufferers take clopidogrel(75mg/d)orally for 7 days.Collecting 2-3ml of venous blood.The maximum blood platelet aggregation rate(MAR)was detected by PL-16 blood platelet function analyzer with Denosine diphosphate(ADP)as inducer.CR group was known as MAR>50%,and NCR group was known as MAR≤50%.4.At the same time,Detecting the genes of CYP2C19*2(681G>A)and*3(636G>A)in all sufferers.According to the results,they were divided into extended metabolizer(EM),with no mutation of two sites(*1/*1);intermediate metabolizer(IM)group,It is a heterozygote with a mutation at one of the two sites(*1/*2 or*1/*3);poor metabolizera(PM)group which is homozygous(*2/*2 or*3/*3),with mutation at one of the two sites,or*2/*3 with mutation at both sites.5.To analyze the correlation between CR and CYP2C19 gene polymorphism.Results:1.According to MAR test results:142 sufferers with CIS were divided into CR group(72 cases,50.70%)and NCR group(70 cases,49.30%).There was no significant difference in the bases data between the two groups(P>0.05).2.According to the results of genes:142 sufferers with CIS were divided into EM group(54 cases),IM group(71 cases)and PM group(17 cases).The MAR(40.90±19.14 vs 52.87±16.84,57.87 ± 16.68,P<0.05)of the three groups was statistically significant,while the MAR(52.87±16.84 vs 57.87±16.68,P>0.05)of IM group and PM group was not statistically significant.3.The proportion of CR in EM,IM and PM groups was 31.4%(17 cases),63.38%(45 cases)and 58.82%(10 cases)respectively,and the difference was statistically significant(P<0.05).The proportion of CR was higher in IM and PM groups.4.The proportion of CR was 37.88%(25 cases),63.33%(38 cases)and 56.25%(9 cases)in the three genes of CYP2C19*2(GG,GA and AA).There was a significant difference in the proportion of CR among the three genes(P<0.05);sufferers with CYP2C19*2 changing suddenly had a higher probability of CR than without changing suddenly.5.The proportion of CR was 48.84%(63 cases),69.23%(9 cases)and 0%(0 case)in the three genes of CYP2C19*3(GG,GA and AA).There was no significant difference in the proportion of CR among the three genes(P>0.05).6.Putting age,gender,smoking,drinking,hypertension,hyperlipidemia,diabetes,CYP2C19 gene polymorphism as independent variables and CR as dependent variables,multivariate logistic regression analysis showing that CYP2C19 gene polymorphism is a danger factor of CR.7.By drawing the ROC curve of CR and CYP2C19 gene polymorphism,we found that genes detection method had a high predictive value for CR(area under the curve>0.5).Conclusion:1.CYP2C19 gene polymorphism is a hazard factor for CR,and sufferers with intermediate metabolizer and poor metabolizera are more likely to develop CR than extended metabolizer.2.Sufferers with CYP2C19*2 sudden changing have a higher danger of CR than without CYP2C19*2 sudden changing.3.Clinicians can judge whether sufferers have CR through the results of genotype test,and timely change the treatment plan for sufferers with CR,so as to improve the prognosis of these sufferers and reduce the recurrence rate of ischemic events. |
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