【摘要】 目的 探讨氯吡格雷给药后患者血小板反应性与患者CYP2C19基因型的关系。方法 选取北京市垂杨柳医院神经内科2021年5月至7月患者60例，连续服用抗血小板药物3天后采用PL-12血小板功能分析仪检测患者服用氯吡格雷前后的血小板聚集率，计算其血小板抑制率；采用PCR-熔解曲线法检测患者的CYP2C19基因型（*1,*17,*2和*3），并将患者按照基因检测结果分为不同代谢类型。采用统计学方法分析CYP2C19不同代谢类型患者血小板抑制率的差异。结果 60例患者共检测4种等位基因，8种基因型。根据CYP2C19基因多态性进行代谢分型，强代谢型（EM)26例，中间代谢型（IM)20例，弱代谢型（PM)14例。血小板聚集率在弱代谢型中较强代谢型高，差异有统计学意义（χ~2=0.174,P<0.05）；弱代谢型与中间代谢型的血小板聚集率差异无统计学意义（χ~2=0.015,P>0.05）；血小板聚集率在中间代谢型中较强代谢型高，差异无统计学意义（χ~2=0.983,P>0.05）。结论 CYP2C19基因位点突变会导致患者出现对氯吡格雷的反应的差异性，影响患者使用氯吡格雷后血小板聚集率。更多还原

【Abstract】 Objective To investigate the relationship between platelet reactivity and CYP2C19 genotype in patients with cerebral infarction after clopidogrel administration.Methods 60 patients with cerebral infarction at the neurology department of Beijing Chui Yang Liu Hospital were selected to receive treatment with clopidogrel.The platelet aggregation rate was measured using PL-12 platelet function analyzer.The patients’CYP2C19 gene polymorphism (*1,*2,*3 and*17) was determined using the PCR-melting curve method,and they were divided into different metabolic types based on the genetic test results.The difference of platelet aggregation rate in patients with different metabolic types of CYP2C19 was analyzed using statistical methods.Results A total of 60 patients were tested for 4 alleles and 8 genotypes.According to the CYP2C19gene polymorphism,there were 26 cases of strong metabolic type (EM),20 cases of intermediate metabolic type (IM),and 14 cases of poor metabolic type (PM).Platelet aggregation rate is higher in the stronger metabolic type among the weaker metabolic types,and the difference was statistically significant（χ~2=0.174,P<0.05).There was no statistically significant difference in platelet aggregation rate between poor metabolized and intermediate metabolized types（χ~2=0.015,P>0.05).Platelet aggregation rate was higher among intermediate metabolic types compared to poor metabolic types,with no statistically significant difference（χ~2=0.983,P>0.05).Conclusion A mutation at the CYP2C19 gene site can cause variations in how patients respond to clopidogrel, impacting their platelet aggregation rate. Therefore, it is important to tailor antiplatelet therapy based on the patient’s CYP2C19 metabolic status to optimize the therapeutic outcome.更多还原