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老年缺血性脑卒中患者CYP2C19基因多态性对血小板功能、炎症细胞因子的影响及预后不良因素分析
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| 篇名： | 老年缺血性脑卒中患者CYP2C19基因多态性对血小板功能、炎症细胞因子的影响及预后不良因素分析 |
| TITLE： | Influence of CYP2C19 gene polymorphism on platelet function and inflammatory cytokines and analysis of factors associated with poor prognosis in elderly patients with ischemic stroke |
| 摘要： | 目的 探讨老年缺血性脑卒中患者CYP2C19基因多态性对血小板功能、炎症细胞因子的影响，并分析造成患者预后不良的潜在因素。方法回顾性收集2024年6月至2025年6月我院收治的接受CYP2C19基因型检测并接受氯吡格雷抗血小板治疗的老年缺血性脑卒中患者的临床资料。比较不同代谢型患者治疗前后血小板功能指标和炎症细胞因子水平。依据治疗6个月后的预后情况，将患者分为预后不良组和预后良好组，对其一般资料、代谢型、血小板功能指标以及炎症细胞因子水平进行单因素分析，将P＜0.05的变量和治疗前炎症细胞因子水平纳入多因素Logistic回归分析，筛选造成患者预后不良的独立危险因素；采用多元线性回归进一步分析代谢型与炎症细胞因子的关系。结果共纳入老年缺血性脑卒中患者448例；其中正常代谢型162例，中间代谢型218例，慢代谢型68例，未见快代谢型和超快代谢型。治疗后，正常代谢型组、中间代谢型组和慢代谢型组患者的血小板聚集率和P选择素、血小板活化复合物1、超敏C反应蛋白（hs-CRP）、白细胞介素1β（IL-1β）、IL-6、肿瘤坏死因子α（TNF-α）水平（慢代谢型患者的血小板聚集率和P选择素、血小板活化复合物1水平除外）均显著低于同组治疗前，且正常代谢型组上述指标水平均显著低于同期中间代谢型组、慢代谢型组，中间代谢型组血小板功能指标水平均显著低于同期慢代谢组（P＜0.05）。单因素和多因素Logistic回归分析结果显示，合并高血压、合并糖尿病、代谢型为中间代谢型及慢代谢型是老年缺血性脑卒中患者预后不良的独立危险因素（P＜0.05）。多元线性回归分析结果显示，中间代谢型和慢代谢型组治疗前的血清hs-CRP、IL-1β、IL-6、TNF-α水平均较正常代谢型组显著升高（P＜0.05），且慢代谢型的炎症细胞因子水平升高幅度更大。结论CYP2C19中间代谢型和慢代谢型老年缺血性脑卒中患者的血小板抑制效果较差，炎症细胞因子水平较正常代谢型高；CYP2C19基因多态性和合并高血压、糖尿病可作为预后不良的独立预测指标。 |
| ABSTRACT： | OBJECTIVE To investigate the influence of CYP2C19 gene polymorphism on platelet function and inflammatory cytokines in elderly patients with ischemic stroke， and to analyze potential factors associated with poor prognosis. METHODS A retrospective study was conducted on elderly patients with ischemic stroke admitted to our hospital from June 2024 to June 2025， wh o underwent CYP2C19 genotype testing and received antiplatelet therapy with clopidogrel. The levels of platelet function indicators and inflammatory cytokines before and after treatment were compared among patients with different metabolic phenotypes. Based on the prognosis at 6 months post-treatment， patients were divided into poor prognosis group and good prognosis group. Univariate analysis was performed on general data， metabolic phenotype， the levels of platelet function indicators and inflammatory cytokines. Variables with P ＜0.05 and the levels of inflammatory cytokines before treatment were included in a multivariate Logistic regression analysis to identify independent risk factors for poor prognosis. Multiple linear regression was used to further analyze the relationship between metabolic phenotypes and inflammatory cytokines. RESULTS A total of 448 elderly patients with ischemic stroke were included； among them， 162 cases were normal metabolic phenotype， 218 were intermediate metabolic phenotype， and 68 were poor metabolic phenotype. No rapid or ultrarapid metabolic phenotypes were observed. After treatment， platelet aggregation rate， the levels of P-selectin and platelet activated complex-1 （PAC-1）， high-sensitivity C-reactive Protein （hs-CRP）， interleukin-1β （IL-1β）， IL-6 and tumor necrosis factor-α （TNF-α） in the normal metabolic phenotype group， intermediate metabolic phenotype group， and poor metabolic phenotype group （except for platelet aggregation rate， and the levels of P-selectin and PAC-1 in the poor metabolic phenotype group） were significantly lower than those before treatment in the same group. Moreover， the above indicators in the normal metabolic phenotype group were significantly lower than those in the intermediate and poor metabolic phenotype groups at the corresponding time， and the levels of platelet function indicators in the intermediate metabolic phenotype group were significantly lower than those in the poor metabol ic phenotype group at the corresponding time （ P ＜0.05）. Univariate and multivariate Logistic regression analyses showed that combined with hypertension， combined with diabetes mellitus， and intermediate or poor metabolic genotypes were independent risk factors for poor prognosis in elderly patients with ischemic stroke （ P ＜0.05）. Multiple linear regression analysis showed that serum levels of hs-CRP， IL-1β， IL-6 and TNF-α before treatment were significantly higher in patients with intermediate and poor metabolic genotypes compared to those with normal metabolic genotype （ P ＜0.05）， with a greater magnitude of increase in inflammatory cytokines observed in the patients with poor metabolic genotype. CONCLUSIONS The elderly ischemic stroke patients with CYP2C19 intermediate and poor metabolic genotypes have poor inhibition effect on platelet and higher levels of inflammatory cytokines than normal metabolic genotype； CYP2C19 gene polymorphism， and in combination with hypertension and diabetes， can be used as independent predictors of poor prognosis. |
| 期刊： | 2026年第37卷第06期 |
| 作者： | 梁海；张红；夏茹楠；陈慧娟；姜梦雨；李璠琴；狄潘潘；杨淼 |
| AUTHORS： | LIANG Hai， ZHANG Hong，XIA Runan，CHEN Huijuan，JIANG Mengyu，LI Fanqin，DI Panpan，YANG Miao |
| 关键字： | 缺血性脑卒中；抗血小板治疗；CYP2C19基因多态性；老年患者；预后不良；个体化治疗 |
| KEYWORDS： | ischemic stroke； antiplatelet therapy； CYP2C19 gene polymorphism； elderly patients； poor prognosis； |
| 阅读数： | 3 次 |
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