Application Of CYP2C19 Gene Detection In Stent-assisted Embolization Of Intracranial Aneurysms In Northeast China

Objectives:To investigate the distribution of CYP2C19 gene polymorphism in the population in Northeast China,the effect of gene types on metabolism of clopidogrel after intracranial stent-assisted embolization,and the relationship between them.Methods : A retrospective analysis of 102 patients who were diagnosed with intracranial aneurysms and undergoing stent-assisted embolization in the People's Hospital of China Medical University from September 2017 to August 2019.The CYP2C19 gene test was performed before surgery.The thromboelastic chart was used to detect the ADP inhibition rate after operation.Statistical analysis of genetic test results,ADP inhibition rate,risk factors for postoperative cerebral hemorrhage and ischemia,etc.Results:1)Among the 102 patients,31cases(30.39%)of * 1 / * 1,35 cases(34.31%)of * 1 / * 2,(7.84%)of * 1 / * 3,and * 2 / * 2 of 16 cases(15.69%),4 cases(2.94%)of * 2 / * 3,8cases(7.84%)of * 1 / * 17,* 3 / * 3 and * 17 / * 17 were not detected.2)Slow metabolizing type 19.60%,intermediate metabolizing type 42.16%,fast metabolizing type 30.39%,ultra fast metabolizing type 7.84%,intermediate metabolizing type is the most common type of metabolism,and ultrafast metabolizing type is the lowest.3)Comparison of ADP inhibition rates of different metabolic types.Using analysis of variance,we can see that there are differences in ADP inhibition rates between different metabolic types.Using LSD pairwise comparison,we can know that the ADP inhibition rate increases gradually with the increase of metabolism.However,there is no statistically significant difference between fast metabolite and ultrafast metabolite.4)For the results of univariate analysis,using Logistic regression analysis,we can know whether the occurrence of cerebral hemorrhage after operation is related to metabolic typing.The presence of cerebral ischemic events after surgery is related to age and metabolic typing.The probability of cerebral ischemic events increases with age,and the probability of cerebral ischemia increases with decreased metabolism(P<0.05).Conclusions : 1)Among CYP2C19 gene polymorphisms in patients with stent-assisted embolization of intracranial aneurysms in Northeast China,CYP2C19 *1 / * 1 is the most common,and CYP2C19 * 2 / * 2,* 2 / * 3 are the most common functional deletion alleles.There are fewer ultrafast metabolizing CYP2C19 * 1 / *17.2)Postoperative cerebrovascular events are significantly related to the CYP2C19 gene,especially slow metabolizers and intermediate metabolizers,which may be closely related to the occurrence of clopidogrel resistance.3)The detection of CYP2C19 gene polymorphism can be used to predict the risk of cerebral ischemia and hemorrhage in patients with different gene types after surgery,and provide a reference for clinical.