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重磅!王拥军教授团队脑血管病精准医学研究成果被JAMA接收发表

2016-06-24 MedSci MedSci原创

目前关于CYP2C19基因突变在氯吡格雷治疗小卒中或短暂性脑缺血发作中效果的研究甚少。本研究旨在评估CYP2C19基因突变与氯吡格雷治疗小卒中或短暂性脑缺血发作的临床结局之间的关联。研究共纳入73个地区的2933名中国患者,1948名(66.4%)为男性,平均年龄为62.4岁。这些患者参与了2010年1月2日至2012年3月20日进行的CHANCE随机试验。对三个CYP2C19主要等位基因(*2,

导语:首都医科大学附属北京天坛医院王拥军教授团队关于脑血管病精准医学研究的突破性进展于6月23日在线发表于《美国医学会杂志》(JAMA)。研究显示,使用阿司匹林联合氯吡格雷仅可降低未携带CYP2C19功能缺失等位基因患者的新的卒中发生率。




王拥军教授

研究摘要如下:

目前关于CYP2C19基因突变在氯吡格雷治疗小卒中或短暂性脑缺血发作中效果的研究甚少。本研究旨在评估CYP2C19基因突变与氯吡格雷治疗小卒中或短暂性脑缺血发作的临床结局之间的关联。

研究共纳入73个地区的2933名中国患者,1948名(66.4%)为男性,平均年龄为62.4岁。这些患者参与了2010年1月2日至2012年3月20日进行的CHANCE随机试验。对三个CYP2C19主要等位基因(*2, *3, *17)进行基因分型。将患者随机分为氯吡格雷联合阿司匹林治疗组和仅阿司匹林治疗组。

主要疗效结局为新发脑卒中。次要疗效结局为新复合血管事件的组合(缺血性中风,出血性中风,心肌梗死,或血管性死亡)。出血列为安全的结局。

总体而言,1207名(41.2%)患者为非携带者,1726名(58.8%)患者为功能缺失等位基因(*2, *3)的携带者。随访90天后发现,氯吡格雷联合阿司匹林治疗可降低非携带者的卒中发生率,但是并未降低功能缺失等位基因携带者的卒中发生率。对于次要疗效结局也发现了类似的结果。两组患者之间对于出血的治疗的影响并无差异。

总而言之,对于轻度缺血性卒中或短暂性脑缺血发作的患者来说,与仅使用阿司匹林治疗相比,使用阿司匹林联合氯吡格雷仅可降低未携带CYP2C19功能缺失等位基因患者的新的卒中发生率。这些研究发现支持了CYP2C19基因型在这种治疗方法的作用。

王拥军教授曾在《脑血管病精准医学路线图》中指出:“脑血管病精准医学的总体目标:以国家战略需求为导向,以解决研究和应用的瓶颈问题为重点,以新兴生物医学技术、脑网络连接分析技术、生物信息分析技术与大数据处理技术为支撑,脑血管病预警、诊断与干预研究衔接部署,基础研究、临床转化、循证评价、示范应用、新业态孵育一体化布局,有效整合我国资源优势,建设脑血管病医疗健康大数据平台,以精准医学研究催化脑血管病新型医疗模式。实现脑血管病精准预警、精准诊断与精准干预,全面提升脑血管病防控能力,逆转我国脑血管病高发生率和高死亡率的趋势,优化医疗费用-收益比;在惠及民生的同时,孵化催生精准医疗新业态,造就新的经济增长点。”

此项突破性进展更是让脑血管病的精准治疗益处崭露头角。通过检测患者基因情况,进而制定更加个体化的治疗方案,减少氯吡格雷不敏感轻型卒中或TIA患者复发的几率,将直接减少众多卒中患者巨大的医疗开销。

原始出处:

Yilong Wang, Xingquan Zhao, et al., Association Between CYP2C19 Loss-of-Function Allele Status and Efficacy of Clopidogrel for Risk Reduction Among Patients With Minor Stroke or Transient Ischemic Attack. JAMA. Published online June 23, 2016. doi:10.1001/jama.2016.8662.

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22:34:18 CST 2016, time=2016-10-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=146153, encodeId=20ec146153d5, content=好文,值得推荐。, beContent=null, objectType=article, channel=null, level=null, likeNumber=106, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7s7ZCKOmmbBTD6nE7gcd5OZpvyGEzkxBP3S275k5ZJVrsPkotZhBglRHM9rKvcj1OgkssqhcnoPw8zIaMZTF8c/0, createdBy=4c441942088, createdName=ylzr123, createdTime=Tue Oct 11 22:45:54 CST 2016, time=2016-10-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1644487, encodeId=1801164448eaa, content=<a href='/topic/show?id=e3eb89e17fb' target=_blank style='color:#2F92EE;'>#血管病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89717, encryptionId=e3eb89e17fb, topicName=血管病)], attachment=null, 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    2018-03-03 1e145228m78(暂无匿称)

    学习了.谢谢作者分享!

    0

  2. 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    2017-07-15 易休

    明显这个人不叫王拥军嘛,编辑怎么搞的

    0

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ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=91100, encodeId=ebbe9110018, content=国人科研越来越强, beContent=null, objectType=article, channel=null, level=null, likeNumber=141, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=90f31612316, createdName=xiaotaiyang1, createdTime=Sat Jun 25 12:41:00 CST 2016, time=2016-06-25, status=1, ipAttribution=)]
  4. 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target=_blank style='color:#2F92EE;'>#医学研究#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=58, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=34183, encryptionId=509b3418366, topicName=医学研究)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a4b713593170, createdName=ms1065684921169360, createdTime=Sun Jun 26 02:12:00 CST 2016, time=2016-06-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1548854, encodeId=9ccc1548854f9, content=<a href='/topic/show?id=f7879600061' target=_blank style='color:#2F92EE;'>#重磅#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=96000, encryptionId=f7879600061, topicName=重磅)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=3acc14121561, createdName=xxxx1054, createdTime=Sun Jun 26 02:12:00 CST 2016, time=2016-06-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=91100, encodeId=ebbe9110018, content=国人科研越来越强, beContent=null, objectType=article, channel=null, level=null, likeNumber=141, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=90f31612316, createdName=xiaotaiyang1, createdTime=Sat Jun 25 12:41:00 CST 2016, time=2016-06-25, status=1, ipAttribution=)]
    2016-10-13 苏措1234551

    好文

    0

  5. 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22:34:18 CST 2016, time=2016-10-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=146153, encodeId=20ec146153d5, content=好文,值得推荐。, beContent=null, objectType=article, channel=null, level=null, likeNumber=106, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7s7ZCKOmmbBTD6nE7gcd5OZpvyGEzkxBP3S275k5ZJVrsPkotZhBglRHM9rKvcj1OgkssqhcnoPw8zIaMZTF8c/0, createdBy=4c441942088, createdName=ylzr123, createdTime=Tue Oct 11 22:45:54 CST 2016, time=2016-10-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1644487, encodeId=1801164448eaa, content=<a href='/topic/show?id=e3eb89e17fb' target=_blank style='color:#2F92EE;'>#血管病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89717, encryptionId=e3eb89e17fb, topicName=血管病)], attachment=null, 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target=_blank style='color:#2F92EE;'>#医学研究#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=58, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=34183, encryptionId=509b3418366, topicName=医学研究)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a4b713593170, createdName=ms1065684921169360, createdTime=Sun Jun 26 02:12:00 CST 2016, time=2016-06-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1548854, encodeId=9ccc1548854f9, content=<a href='/topic/show?id=f7879600061' target=_blank style='color:#2F92EE;'>#重磅#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=96000, encryptionId=f7879600061, topicName=重磅)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=3acc14121561, createdName=xxxx1054, createdTime=Sun Jun 26 02:12:00 CST 2016, time=2016-06-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=91100, encodeId=ebbe9110018, content=国人科研越来越强, beContent=null, objectType=article, channel=null, level=null, likeNumber=141, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=90f31612316, createdName=xiaotaiyang1, createdTime=Sat Jun 25 12:41:00 CST 2016, time=2016-06-25, status=1, ipAttribution=)]
    2016-10-11 ylzr123

    好文,值得推荐。

    0

  6. 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  7. 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22:34:18 CST 2016, time=2016-10-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=146153, encodeId=20ec146153d5, content=好文,值得推荐。, beContent=null, objectType=article, channel=null, level=null, likeNumber=106, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7s7ZCKOmmbBTD6nE7gcd5OZpvyGEzkxBP3S275k5ZJVrsPkotZhBglRHM9rKvcj1OgkssqhcnoPw8zIaMZTF8c/0, createdBy=4c441942088, createdName=ylzr123, createdTime=Tue Oct 11 22:45:54 CST 2016, time=2016-10-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1644487, encodeId=1801164448eaa, content=<a href='/topic/show?id=e3eb89e17fb' target=_blank style='color:#2F92EE;'>#血管病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89717, encryptionId=e3eb89e17fb, topicName=血管病)], attachment=null, 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  8. 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22:34:18 CST 2016, time=2016-10-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=146153, encodeId=20ec146153d5, content=好文,值得推荐。, beContent=null, objectType=article, channel=null, level=null, likeNumber=106, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7s7ZCKOmmbBTD6nE7gcd5OZpvyGEzkxBP3S275k5ZJVrsPkotZhBglRHM9rKvcj1OgkssqhcnoPw8zIaMZTF8c/0, createdBy=4c441942088, createdName=ylzr123, createdTime=Tue Oct 11 22:45:54 CST 2016, time=2016-10-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1644487, encodeId=1801164448eaa, content=<a href='/topic/show?id=e3eb89e17fb' target=_blank style='color:#2F92EE;'>#血管病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89717, encryptionId=e3eb89e17fb, topicName=血管病)], attachment=null, 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target=_blank style='color:#2F92EE;'>#医学研究#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=58, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=34183, encryptionId=509b3418366, topicName=医学研究)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a4b713593170, createdName=ms1065684921169360, createdTime=Sun Jun 26 02:12:00 CST 2016, time=2016-06-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1548854, encodeId=9ccc1548854f9, content=<a href='/topic/show?id=f7879600061' target=_blank style='color:#2F92EE;'>#重磅#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=96000, encryptionId=f7879600061, topicName=重磅)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=3acc14121561, createdName=xxxx1054, createdTime=Sun Jun 26 02:12:00 CST 2016, time=2016-06-26, status=1, 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  9. 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22:34:18 CST 2016, time=2016-10-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=146153, encodeId=20ec146153d5, content=好文,值得推荐。, beContent=null, objectType=article, channel=null, level=null, likeNumber=106, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7s7ZCKOmmbBTD6nE7gcd5OZpvyGEzkxBP3S275k5ZJVrsPkotZhBglRHM9rKvcj1OgkssqhcnoPw8zIaMZTF8c/0, createdBy=4c441942088, createdName=ylzr123, createdTime=Tue Oct 11 22:45:54 CST 2016, time=2016-10-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1644487, encodeId=1801164448eaa, content=<a href='/topic/show?id=e3eb89e17fb' target=_blank style='color:#2F92EE;'>#血管病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89717, encryptionId=e3eb89e17fb, topicName=血管病)], attachment=null, 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ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=91100, encodeId=ebbe9110018, content=国人科研越来越强, beContent=null, objectType=article, channel=null, level=null, likeNumber=141, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=90f31612316, createdName=xiaotaiyang1, createdTime=Sat Jun 25 12:41:00 CST 2016, time=2016-06-25, status=1, ipAttribution=)]
    2016-06-26 xxxx1054
  10. 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22:34:18 CST 2016, time=2016-10-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=146153, encodeId=20ec146153d5, content=好文,值得推荐。, beContent=null, objectType=article, channel=null, level=null, likeNumber=106, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7s7ZCKOmmbBTD6nE7gcd5OZpvyGEzkxBP3S275k5ZJVrsPkotZhBglRHM9rKvcj1OgkssqhcnoPw8zIaMZTF8c/0, createdBy=4c441942088, createdName=ylzr123, createdTime=Tue Oct 11 22:45:54 CST 2016, time=2016-10-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1644487, encodeId=1801164448eaa, content=<a href='/topic/show?id=e3eb89e17fb' target=_blank style='color:#2F92EE;'>#血管病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89717, encryptionId=e3eb89e17fb, topicName=血管病)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=64bb23195917, createdName=Luyuxie_17, createdTime=Thu Nov 10 12:12:00 CST 2016, time=2016-11-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1403048, encodeId=3e9b140304828, content=<a href='/topic/show?id=ebbde6353be' target=_blank style='color:#2F92EE;'>#精准#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=76353, encryptionId=ebbde6353be, topicName=精准)], attachment=null, authenticateStatus=null, createdAvatar=https://thirdwx.qlogo.cn/mmopen/vi_32/DYAIOgq83epQX9hfEIBiaPg0e9KvLYVBCSGYydH6K6OQxBh3RaOC0TYP9HYy2v0XdHib1LFnZNU5Siak0P8oh8Aqw/132, createdBy=acd92440184, createdName=shijzhiewnjhch, createdTime=Sun Jun 26 02:12:00 CST 2016, time=2016-06-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1543615, encodeId=fe5c15436157b, content=<a href='/topic/show?id=509b3418366' target=_blank style='color:#2F92EE;'>#医学研究#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=58, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=34183, encryptionId=509b3418366, topicName=医学研究)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a4b713593170, createdName=ms1065684921169360, createdTime=Sun Jun 26 02:12:00 CST 2016, time=2016-06-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1548854, encodeId=9ccc1548854f9, content=<a href='/topic/show?id=f7879600061' target=_blank style='color:#2F92EE;'>#重磅#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=96000, encryptionId=f7879600061, topicName=重磅)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=3acc14121561, createdName=xxxx1054, createdTime=Sun Jun 26 02:12:00 CST 2016, time=2016-06-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=91100, encodeId=ebbe9110018, content=国人科研越来越强, beContent=null, objectType=article, channel=null, level=null, likeNumber=141, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=90f31612316, createdName=xiaotaiyang1, createdTime=Sat Jun 25 12:41:00 CST 2016, time=2016-06-25, status=1, ipAttribution=)]
    2016-06-25 xiaotaiyang1

    国人科研越来越强

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