Correlation Between CYP2C19 Gene Polymorphism And Clinical Prognosis In Patients With High-risk Non-disabling Ischemic Stroke

Objective: The purpose of this study is to explore the high-risk non-disabling ischemic cerebrovascular events(HR-NICE)patients.After 90 days of clopidogrel treatment,each patient is given a CYP2C19 gene polymorphism test,and the best treatment scheme is given according to the test.The prognosis of patients is observed,and the future treatment is guided according to the different metabolic types and specific conditions of different patients,so as to improve the prognosis and use drugs accurately.And provide a reference for further reducing the recurrence rate of stroke and popularizing the technology related to gene polymorphism.Methods: The patients who met the requirements of "high-risk non-disabled ischemic stroke" who were hospitalized in the Department of Neurology of our hospital from April2018 to September 2019 were collected.According to the relevant guidelines of acute cerebrovascular diseases and the opinions recommended by expert consensus,drug treatment was given: aspirin tablets 100mg/d+ clopidogrel 300mg/d on the same day,clopidogrel adjusted to 75mg/d on the next day,and clopidogrel only used 75mg/d three weeks later,for90 days.After 90 days,patients were followed up and given CYP2C19 gene polymorphism detection to determine different metabolic types of patients According to the number of patients with recurrence in different metabolic types,the possibility of recurrence of ischemic stroke and the safety of medication can be judged.Results:A total of 140 patients with HR-NICE were included in the final study,including32 patients with recurrent ischemic stroke,including UM 0,NM 10(31.3%),IM 10(31.3%)and PM 12(37.4%).There were 108 cases in the non-recurrence group,including UM 0,NM59(54.6),IM 33(30.6%)and PM 16(14.8%).By comparing several different metabolic types,it was found that the difference among patients with NM,IM and PM was statistically significant(P =0.011),and the curative effects of the three were different.Multivariate Logistic regression analysis showed that slow metabolism(OR(odds ratio)= 2.187,95% CI(confidence interval)1.285 ～ 3.722,P=0.004)was correlated with the recurrence of ischemic stroke.Kaplan-Meier analysis showed that the recurrence of patients mainly occurred within20～60 days after onset,and the recurrence-free rate of patients in fast metabolism group was significantly higher than that in middle metabolism group and slow metabolism group(P=0.009),which indicated that patients should be highly vigilant against the recurrence of stroke and take active treatment measures during this period.Conclusion:(1)Patients with PM are prone to recurrent ischemic stroke within 60 days after onset.(2)Among the relapsed people,PM and IM patients are the main ones.(3)Besides common risk factors,the recurrence of ischemic stroke is related to PM,...