本文選題：肝硬化　切入點：頸靜脈肝內(nèi)門體分流術(shù)　出處：《介入放射學(xué)雜志》2017年07期

【摘要】：目的評估細(xì)胞色素P450酶2C19(CYP2C19)基因多態(tài)性對經(jīng)頸靜脈肝內(nèi)門體分流術(shù)(TIPS)肝硬化患者術(shù)后服用氯吡格雷抗血小板治療的影響。方法收集2013年1月至2014年12月接受TIPS術(shù)治療的171例肝硬化患者臨床資料。所有患者均于術(shù)中采集門靜脈及肘靜脈血液樣本并行CYP2C19基因檢測。術(shù)后每3個月臨床隨訪,比較分析基因檢測結(jié)果與臨床隨訪結(jié)果。結(jié)果 110例TIPS術(shù)前無輸血且術(shù)后規(guī)律服用氯吡格雷患者納入本研究。術(shù)后平均服用氯吡格雷時間為192.4 d(31~517 d),門靜脈血及肘靜脈血基因檢測結(jié)果一致,CYP2C19基因型為*1/*1有49例(44.5%)、*1/*2有27例(24.6%)、*1/*3有18例(16.4%)、*2/*2有11例(10.0%)、*2/*3有3例(2.7%)、*3/*3有2例(1.8%);隨訪顯示慢代謝型基因攜帶患者分流道功能異常發(fā)生率為87.5%(14/16),較中等代謝型患者(20.0%,9/45,χ2=22.9,P=0.006)及快代謝型患者(8.2%,4/49,χ2=37.91,P=0.000 1)明顯增高;Cox回歸模型多變量分析提示CYP2C19慢代謝型基因變異,是分流道功能異常的重要預(yù)測因素(95%CI 1.80~9.03,P=0.000 7)。結(jié)論 CYP2C19慢代謝基因變異(*2/*2、*2/*3、*3/*3)是影響TIPS術(shù)后患者氯吡格雷治療效果的重要因素之一,術(shù)前檢測可為術(shù)后提供較為有效的抗血小板治療方案。
[Abstract]:Objective to evaluate the effect of cytochrome P450 enzyme 2C19 (CYP2C19) gene polymorphism on antiplatelet therapy of clopidogrel in patients with liver cirrhosis undergoing intrahepatic portosystemic shunt via jugular vein. Methods from January 2013 to December 2014, TIPS was used to treat patients with liver cirrhosis. The clinical data of 171 patients with liver cirrhosis were collected during operation. Blood samples of portal vein and cubital vein were collected and CYP2C19 gene was detected. Results 110patients without blood transfusion before TIPS and regular clopidogrel after operation were included in this study. The average duration of clopidogrel was 192.4 days after operation, portal vein blood and elbow. There were 49 cases with CYP2C19 genotypes: 44.55.51% of them had 27 cases with 24. 6% of them, 18 cases with CYP2C19 genotype were 16. 440%, 11 cases were in 10. 0% 3, 3 cases were 2. 7% 3, 2 cases were 1. 8%; follow up showed that the incidence of shunt dysfunction in patients with slow metabolic gene was 87.5% 14 / 16%, which was higher than that in patients with slow metabolic type gene carrying the slow metabolic gene (87.5% 16%), which was higher than that of the patients with slow metabolic type gene carrying the slow metabolic type gene (P / P 3), and the incidence of shunt dysfunction was 87.5% 16% in the patients with slow-metabolic gene carrying the gene, and the incidence of shunt dysfunction was 87.5% 16% in the patients with slow metabolic gene. In metabolic type patients, 9 / 45, 蠂 2 + 22. 9% P0. 006) and 8. 2% 4 / 49, 蠂 2 + 37. 91% P0. 000 1) were significantly increased in patients with metabolic type. Multivariate analysis of Cox regression model suggested that CYP2C19 gene mutation in slow metabolic type was significantly increased. It is an important predictor of shunt dysfunction. Conclusion the variation of CYP2C19 slow metabolism gene is 2 / 2 / 2 / 3 / 3 / 3), which is one of the important factors that affect the therapeutic effect of clopidogrel after TIPS. Preoperative detection can provide more effective antiplatelet therapy for postoperative patients.
【作者單位】： 貴州醫(yī)科大學(xué)附屬醫(yī)院介入科;
【基金】：貴州省科技計劃項目(SY2012-3145)
【分類號】：R575.2

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