华法林基因多态性检测指导用药对房颤患者INR、TTR值的影响

doi:10.3969/j.issn.1671-7171.2023.02.016

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摘要【目的】探讨华法林基因多态性检测指导用药对房颤患者初始国际标准化比值(INR)及INR在目标范围时间的百分比(TTR)值的影响。【方法】112例给予华法林治疗的房颤患者,根据给药方式不同分为观察组(n=59,根据华法林基因多态性检测指导用药)和对照组(n=53,采用经验性给药)。分析观察组不同基因型分布情况,比较观察组不同基因型患者华法林预测剂量及稳态剂量。比较观察组和对照组过度抗凝事件(INR＞3.5事件)及抗凝不足事件(INR＜1.2事件)的发生情况,对比观察组和对照组INR在不同时间内的TTR差异及不良事件发生率。【结果】观察组CYP2C9*3基因型和VKORC1基因型分布符合Hardy-Weinberg遗传平衡定律(P>0.05)。CYP2C9*3基因型中AA型、AC型、CC型华法林预测剂量与稳态剂量比较,差异均无统计学意义(P>0.05);VKORC1基因型中AA型、GA型、GG型华法林预测剂量与稳态剂量比较,差异均无统计学意义(P>0.05)。观察组INR＞3.5事件及INR＜1.2事件的发生率均低于对照组(P<0.05)。观察组INR前1个月、前3个月的TTR值明显高于对照组(P<0.05),前6个月的TTR值与对照组比较,差异无统计学意义(P>0.05)。两组不良事件发生率比较,差异无统计学意义(P>0.05)。【结论】华法林基因多态性检测指导用药可使房颤患者INR维持在更稳定范围内,TTR在用药初期达到较高水平,提高用药安全性,值得临床推广。

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	邢昕
	毛电波

关键词 ：心房颤动, 华法林, 基因表达, 多态现象,遗传, 国际标准化比

Abstract：【Objective】To investigate the effect of warfarin gene polymorphism detection on the initial international normalized ratio (INR) and the percentage of time to target (TTR) in patients with atrial fibrillation.【Methods】 A total of 112 patients with atrial fibrillation treated with warfarin were divided into the observation group (n=59,guided by warfarin gene polymorphism detection) and the control group (n=53,administered empirically) according to different administration methods. The distribution of different genotypes in the observation group was analyzed,and the predicted dose and steady-state dose of warfarin in patients with different genotypes in the observation group were compared. The occurrence of excessive anticoagulation events (INR>3.5 events) and insufficient anticoagulation events (INR<1.2 events) were compared between the observation group and the control group,and the difference in TTR and the incidence of adverse events of INR between the observation group and the control group at different times were compared. 【Results】The distribution of CYP2C9 * 3 genotype and VKORC1 genotype in the observation group conformed to Hardy Weinberg genetic balance law (P>0.05). In CYP2C9 * 3 genotype,there was no significant difference between the predicted dose and the steady-state dose of warfarin of AA,AC and CC genotype (P>0.05); There was no significant difference between the predicted dose and the steady dose of warfarin of AA type,GA type and GG type in VKORC1 genotype (P>0.05). The incidences of events with INR>3.5 and INR<1.2 in the observation group were lower than those in the control group (P<0.05). The TTR value of the observation group in the first 1 month and 3 months before INR was significantly higher than that of the control group (P<0.05),and there was no significant difference between the TTR value of the first 6 months and that of the control group (P>0.05). There was no significant difference in the incidence of adverse events between the two groups (P>0.05). 【Conclusion】 Warfarin gene polymorphism detection can maintain the INR of patients with atrial fibrillation in a more stable range,and TTR can reach a higher level at the beginning of drug use,which can improve the safety of drug use and is worthy of clinical promotion.

Key words： Atrial Fibrillation Warfarin Gene Expression Polymorphism, Genetic International Normalized Ratio

收稿日期: 2022-06-30

中图分类号:

R541.71

通讯作者: *E-mail:532823837@qq.com

引用本文:

邢昕, 毛电波. 华法林基因多态性检测指导用药对房颤患者INR、TTR值的影响[J]. 医学临床研究, 2023, 40(2): 216-219.
XING Xin, MAO Dian-bo. Effect of Warfarin Gene Polymorphism Detection on INR and TTR in Patients with Atrial Fibrillation. JOURNAL OF CLINICAL RESEARCH, 2023, 40(2): 216-219.

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http://journal07.magtech.org.cn/yxlcyj/CN/10.3969/j.issn.1671-7171.2023.02.016 或 http://journal07.magtech.org.cn/yxlcyj/CN/Y2023/V40/I2/216

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