在轻微中风或暂时性缺血性发作中,CYP2B6多态和皮多格雷尔的有效性之间的关联
Xin Qiu1,2, Yongbo Zhang3, Hongqiu Gu1,2
1Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (X.Q., H.G., Y.P., Yong Jiang, X.M., Yilong Wang, X.Z., H.L., Yongjun Wang, Z.L.).
Stroke
|June 2, 2023
概括
在轻微的中风患者中,CYP2B6基因变异不会显著改变克洛皮多格雷尔的疗效. 携带者和非携带者都能从阿司匹林加克洛皮多格勒中药中获益,用于二次中风预防.
科学领域:
- 药物基因组学 药物基因组学
- 神经学 神经学
- 心脏病学 心脏病学
背景情况:
- CYP2B6 (cytochrome P450亚家族IIB多6) 对于克洛皮多格雷尔的代谢至关重要.
- 对CYP2B6基因变异对克洛皮多格雷尔在预防轻微事件后二次中风的有效性的影响尚不清楚.
研究的目的:
- 为了研究CYP2B6多态性和 klopidogrel 在中国患者中轻微中风或暂时性缺血性攻击的疗效之间的关联.
- 根据CYP2B6基因型,评估阿司匹林加克洛皮多格雷尔与单独阿司匹林用于二次中风预防的安全性和有效性.
主要方法:
- 对CHANCE随机临床试验的后期分析,该试验涉及2853名患者.
- 对CYP2B6-516G>T (rs3745274) 和CYP2B6-1456T>C (rs2054675) 多形态的基因定型.
- 评估90天内新发生的中风和出血事件以及1年的随访.
主要成果:
- 32.8%的患者携带至少一种CYP2B6变异基因型.
- 在预防新的中风方面,没有发现CYP2B6基因型状态和治疗疗效 (阿司匹林加克洛皮多格雷尔与单独阿司匹林) 之间有显著的相互作用.
- 虽然在统计学上不显著,但变异基因型的携带者在服用阿司匹林加克洛皮多格雷尔时,与单独服用阿司匹林相比,出血事件的发生率更高.
结论:
- 与单独阿司匹林相比,CYP2B6多态性并没有显著改变阿司匹林加克洛皮多格雷尔在预防轻度中风或TIA患者中复发性中风的疗效.
- 无论是CYP2B6变体携带者还是非携带者,都似乎从二次中风预防的联合治疗中受益.
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