The Correlation Between CYP2C19 Gene Polymorphism And Clinical Treatment Of Clopidogrel In Patients With Lower Extremity Arterial Bypass

ObjectiveTo investigate the CYP2C19 gene mutation in patients with femoral artery bypass grafting and the anticoagulant effect of clopidogrel anticoagulant therapy in different genotype patients,to predict the risk of restenosis,and to provide evidence for whether the patient's drug regimen should be adjusted.Materials and MethodThis study selected the lower extremity of long-term use of clopidogrel and aspirin"double-antibody"after admission to our hospital for vascular surgery from April 2015 to April 2018 and undergoing lower extremity femoral artery bypass graft reconstruction(bilateral or unilateral).A total of 82 patients with LEAOD(Lower extremity atherosclerotic occlusive disease)were detected by PCR.The CYP2C19gene mutation type was divided into 1.Strong metabolite group(without carrying mutation gene)according to the type of gene mutation;2.Metabolome(has a defective gene);a weakly metabolized group(carrying two defective genes),and thromboelastography was performed 5 days after oral administration of aspirin plus clopidogrel antiplatelet therapy in two groups to observe ADP receptor pathway induction.Platelet inhibition rate(TEGMAADP%);records the general conditions,medical records,distal outflow tract and postoperative artificial vascular patency rate of the three groups of patients;out-of-hospital drug treatment and follow-up for 12months,based on imaging examination to determine the graft Whether occlusion(complete occlusion or stenosis rate>70%),amputation events,etc.Result1.The total patients participated in the experiment is 82.The genotype test results were as follows:26 cases of CYP2C19*1/*1 type,31 cases of*1/*2 type,15 cases of*1/*3 type,*2/*2 8 cases were type,1 case was*2/*3 type,1 case was*3/*3 type;the frequency of CYP2C19*1 gene was 55.7%;the frequency of gene deletion type CYP2C19*2 was 27.5%,the gene frequency of CYP2C19*3 The 16.7%of the CYP2C19 genotype was consistent with the Hardy-Weinberg genetic balance by chi-square test.The CYP2C19*17 allele was not detected in this experiment.2.According to the above,the CYP2C19 genotype polymorphism test results were divided into EM group,IM group and PM group;the age,sex,history of tobacco and alcohol,history of previous diabetes,history of hypertension,hyperlipidemia among the three groups The basic data such as medical history were statistically analyzed.The mean was t test,and the relative number was analyzed by chi-square test.There was no statistically significant difference(P>0.05).There was a significant difference in the incidence of restenosis between the three groups(p<0.05).3.The thromboelastography method was used to detect the platelet inhibition rate(TEG%MAADP)induced by ADP in 82 patients.The TEG%MAADP values of the three groups were compared by group test.The results showed that the EM group and IM were respectively.The difference of TEG%MAADP between the group and the PM group was statistically significant(P1=0.034,P3=0.028),but the difference between the IM group and the PM group was not statistically significant(p>0.05).4.The definition of ADP-induced platelet aggregation inhibition rate?30% is clopidogrel low response.In this study,25 patients with clopidogrel low response,including EM group 5 cases,IM group 15 For example,in the PM group,5 patients,the data were performed by Fisher's exact probability method,p=0.079,the difference was not statistically significant.The difference in the probability of occurrence of clopidogrel low-response between patients with different genotypes was not statistically significant.5.Among the 82 patients who were followed up,there were 39 cases of intravascular restenosis,including 6(23.0%)in the EM group,27(58.7%)in the IM group,and 6(60.0%)in the PM group.Chi-square test analysis showed that the difference in the incidence of restenosis between the three groups was statistically significant(?~2=9.156,P=0.010).ConclusionThe CYP2C19 allele is closely related to the platelet inhibition rate after clopidogrel administration and the occurrence of restenosis in the bypass graft.It can predict the risk of long-term restenosis and provide a basis for clinicians to adjust the anticoagulation program.