Abstract: AIM: To investigate the effect of CYP2C19 gene polymorphism on the clinical prognosis of elderly patients treated with clopidogrel who suffered acute cerebral infarction.  METHODS: A total of 226 elderly patients with acute cerebral infarction who received aspirin and clopidogrel were prospectively enrolled in this study. The CYP2C19 genotype was detected by DNA microarray chip method. Based on CYP2C19 genotypes, the patients were divided into fast metabolism group, medium metabolism group and slow metabolism group. The National Institutes of Health Stroke Scale (NIHSS) scores before and after treatment were recorded. The changes of NIHSS scores before and after treatment were studied by repeated measurement ANOVA (analysis of variance), the decrease of NIHSS scores before and after treatment was used as the standard to evaluate the prognosis of patients, and the difference of favorable prognosis rate was compared among the three groups. Binary logistic regression analysis was used to explore the prognosis influencing factors of acute cerebral infarction, and adverse drug reactions (ADR) were observed in the three groups. RESULTS: There were 81 patients (35.8%), 108 patients (47.8%) and 37 patients (16.4%) in fast metabolism group, medium metabolism group and slow metabolism group, respectively, with a favorable prognosis rate of 86.4%, 73.1% and 64.9% respectively. There was significant difference in the favorable prognosis rate among the three groups, and fast metabolism group was significantly higher than slow metabolism group (P<0.05). Repeated measurement ANOVA showed that the NIHSS scores of three groups varied with time, and the NIHSS scores of fast metabolism group after treatment were lower than those of medium metabolism group and slow metabolism group, the difference was statistically significant (P<0.05). Binary logistic regression analysis showed that patients in fast metabolism group had a favorable clinical prognosis 3.447 times as much as those in slow metabolism group (OR=3.447, 95% CI: 1.364-8.712, P=0.009). Patients with diabetes had a favorable clinical prognosis 62.7% as those without diabetes (OR=0.627, 95% CI: 0.268-1.331, P=0.001). There was no statistical difference in the total incidence of ADR among the three groups (P>0.05). CONCLUSION: CYP2C19 gene polymorphism has an effect on the clinical prognosis of elderly patients treated with clopidogrel who suffered acute cerebral infarction, and the therapeutic effect on rapid metabolizer is better than that of slow metabolizer.

Key words: CYP2C19, gene polymorphism, acute cerebral infarction, clopidogrel, prognosis