个体化抗血小板治疗对缺血性卒中二级预防的效果研究

目的 研究个体化抗血小板治疗在缺血性卒中二级预防的效果。 方法 选择2013年3月-2014年5月于陕西省人民医院就诊的急性缺血性卒中患者207例，随机分为 常规治疗组与个体化治疗组。常规治疗组应用阿司匹林100 mg/d抗血小板治疗。个体化治疗组应用 Essen卒中风险评分量表（Essen Stroke Risk Score，ESRS）将高危组给予氯吡格雷75 mg/d，低危组给 予阿司匹林100 mg/d抗血小板治疗。7 d后进行血栓弹力图（thromboela stogram，TEG）及CYP2C19基因型 检测，结合TEG及CYP2C19基因型结果，决定抗血小板治疗方案。随访1年，比较个体化治疗组和常规 治疗组患者终点事件发生率。 结果 CYP2C19快代谢基因型、中间代谢基因型患者应用氯吡格雷的血小板抑制率明显高于慢代谢 型，结果差异有显著性（P =0.018，P =0.015）。个体化治疗组（112例）和常规治疗组组（95例）终点事 件发生率差异无显著性（P＞0.01）。 结论 CYP2C19快代谢基因型、中间代谢基因型患者应用氯吡格雷的血小板抑制率明显高于慢代谢 型。与阿司匹林常规治疗方案相比，利用CYP2C19基因多态性与TEG检测指导下的个体化抗血小板方 案未显示降低缺血性卒中后终点事件发生率，可能需要更大规模、随访时间更长的研究。

The Study of Individualized Treatment of Antiplatelet in Secondary Prevention of Ischemic Stroke

Objective To observe the therapeutic effect of individualized treatment of antiplatelet in secondary prevention of ischemic stroke.
Methods A prospective study was carried out in the 207 inpatients of ischemic stroke in Shanxi Provincial People’s Hospital from March, 2013 to May, 2014. The inpatients were randomly divided into individual treatment group and conventional treatment group which used 100 mg/d aspirin in antiplatelet treatment. The individual treatment group adopted Essen Stroke Risk Score (ESRS) and divided the patients into high risk group (treated with 75 mg/d clopidogrel) and low risk group (treated with 100 mg/d aspirin). The antiplatelet protocol was determined based on the result of thromboela stogram (TEG) and CYP2C19 genotype detection after the 7th day. They all were followed up for 1 year to observe their clinical end point events.
Results The platelet inhibition rate of clopidogrel was signiifcantly higher in inpatients of CYP2C19 fast metabolism genotype and medium metabolism genotype than that in poor metabolism genotype, which had signiifcant difference in outcome (P=0.018, P=0.015). The clinical end point event had no statistical signiifcance between individualized treatment group (112 cases) and conventional treatment group (n=95) (P>0.01).
Conclusion The platelet inhibition rate of application of clopidogrel of CYP2C19 fast metabolism genotype and medium metabolism genotype is obviously higher than that of CYP2C19 poor metabolism. The individualized treatment based on the CYP2C19 gene polymorphisms and TEG, compared the application of conventional treatment by aspirin, fails to reduce the incidence of end point events after ischemic stroke, which may require a larger scale and longer follow-up period study.