Correlation Between CYP2C19 And ABCB1 Gene Polymorphism And Clopidogrel Resistance In Patients With Acute Cerebral Infarction In Southern Anhui

Objective: The main purpose of this study is to detect CYP2C19 and ABCB1 genetype in patients with acute cerebral infarction in southern Anhui,analyze their correlation with clopidogrel resistance,and explore the factors related to clopidogrel resistance.At the same time,through the National Institutes of Health Stroke Scale(NIHSS score),the short-term clinical efficacy with different genotypes after antiplatelet therapy with clopidogrel is discussed,providing theoretical evidence for clinical adjustment of antiplatelet drugs and individualized treatment for patients with acute cerebral infarction.Methods: 1.This study included 100 patients with acute cerebral infarction admitted to the Department of Neurology,Yijishan Hospital,Southern Anhui Medical College from August 2018 to January 2020 as the research object,and received 50 mg of clopidogrel(Tejia).2.The patients admitted to the hospital were tested for clopidogrel by fluorescence staining in situ hybridization analysis technology.The patients were divided into fast metabolic group(CYP2C19*1/*1,EM group)and medium metabolic group(CYP2C19 *1/*2,CYP2C19 *1/*3,IM group)according to CYP2C19 genotypes.Slow metabolism group(CYP2C19 *2/*2,CYP2C19 *2/*3 and CYP2C19*3/*3,PM group),and selected patients were divided into CC(wild type),CT(mutant heterozygous type)and TT(mutant homozygous type)according to the presence or absence of mutation at ABCB1(3435C>T)site.3.After taking clopidogrel for 7 days,thromboelastography(TEG)was used to detect the platelet function of patients.According to the detection results,patients were divided into Clopidogrel sensitive(CS)group and Clopidogrel resistance(CR)group,and the correlation between genotypes and CR and CR influencing factors were compared.4.NIHSS score was used to evaluate the short-term clinical efficacy of clopidogrel antiplatelet therapy for patients with cerebral infarction of different genotypes on the day of admission and 7 days after taking clopidogrel therapy.Results: 1.The results showed that there were 37 cases of CYP2C19 fast metabolic type(EM),50 cases of intermediate metabolic type(IM)and 13 cases of slow metabolic type(PM).In ABCB1 gene,there were 40 cases of CC genotype,40 cases of CT genotype and 20 cases of TT genotype.2.There were 29 cases(29%)in CR group and71 cases(71%)in CS group,among which 9 cases,8 cases and 12 cases were CYP2C19 EM,IM and PM patients in CR group respectively.In CR group,there were10 CC genotypes,13 CT genotypes and 6 TT genotypes in ABCB1 gene.The differences among the three groups of CYP2C19 gene are statistically significant(P<0.05),CYP219 gene mutation is related to clopidogrel resistance,and the differences among the three groups of ABCB1 gene are not statistically significant(P >0.05).3.the platelet inhibition rates of cyp2c19 EM,IM and PM patients were(59.03 11.89)%,(56.69 10.12)%,(19.25 5.46)%,among which the platelet inhibition rates of fast metabolic type(em)and slow metabolic type(PM),intermediate metabolic type(IM)and slow metabolic type(PM)were significantly different(p < 0.05).There was no significant difference in platelet inhibition rate between fast metabolizing type(EM)and intermediate metabolizing type(IM)(P>0.05),and there was no significant difference between ABCB1 genotype and platelet inhibition rate(P > 0.05).In general clinical data,the difference was not statistically significant(P > 0.05).4.NIHSS scores were performed on the day of admission and 7 days after taking clopidogrel.The scores of CYP2C19 genotype groups before treatment were not statistically significant(P>0.05).After 7 days of treatment,the scores of the three groups were significantly lower than those before treatment in the same group,and the difference was statistically significant(P<0.05).After 7 days of treatment with clopidogrel,the scores of the three groups were not statistically significant(P>0.05).The scores of ABCB1 genotypes before clopidogrel treatment were not statistically significant(P>0.05).after 7 days of clopidogrel treatment,the scores of the three groups were significantly lower than those before treatment in the same group(P<0.05).after 7 days of clopidogrel treatment,the scores of the three groups were not statistically significant(P>0.05).Conclusion: 1.CYP2C19 genotype is related to clopidogrel resistance in patients with acute cerebral infarction in southern Anhui.Platelet inhibition rate of slow metabolic type is obviously decreased,suggesting that clinicians can adjust the medication of clopidogrel appropriately according to the detection results of clopidogrel genotype and considering various factors.2.ABCB1 gene polymorphism in patients with acute cerebral infarction in southern Anhui may not be correlated with platelet inhibition rate of clopidogrel.3.CYP2C19 and ABCB1 gene polymorphisms in southern Anhui may not be affect the short-term clinical efficacy of patients with acute cerebral infarction,but the recurrence of CYP2C19 and adverse vascular events requires a large sample long-term follow-up study.