基因指导的华法林治疗与传统治疗效果比较的荟萃分析  

Comparison of pharmacogenetic warfarin dosing and traditional warfarin dosing:A Meta-analysis

作　　者：唐文仪 苏敏红 陈剑[1] 刘茂[1] 江宁[1] 伍卫[1] 

机构地区：[1]中山大学附属五院心内科,广东珠海519000

出　　处：《岭南心血管病杂志》2015年第1期87-93,共7页South China Journal of Cardiovascular Diseases

摘　　要：目的系统评价基因指导的华法林治疗的有效性和安全性。方法检索从建库至2013年12月26日Pub Med/Medline、Embase、Cochrane Library、中国生物医学文献服务系统（Sinomed）、万方数据库和中国知网的随机对照试验,采用Rev Man 5.2统计软件对所纳入的数据进行荟萃分析。结果共检索4 716篇相关文献,有10篇文献入选,10项随机对照临床研究共纳入2 585例患者。基因指导的华法林治疗较之于传统治疗,可降低治疗过程中的大出血事件发生率（RR=0.41,95%CI：0.21～0.82）,但尚无充分证据表明国际标准化比值在治疗目标范围内的时间百分比（time within therapeutic range,TTR）、降低治疗过程中栓塞事件的发生率方面有优势[TTR（WWD=4.51%,95%CI：-1.16%～10.18%,P=0.12）;栓塞事件的发生率（RR=0.52,95%CI：0.24-1.12,P=0.1）]。结论目前尚无足够证据认为基因指导的华法林治疗优于传统治疗,仍然需要更多的大规模、多中心、高质量的相关随机对照试验,并且需要注意人种、给药模型不同的影响。Objectives To evaluate the efficacy and safety of pharmacogenetic warfarin dosing. Methods A systematic search on randomized controlled trial data in Pub Med / Medline,EMbase,Cochrane Library,Sinomed,Wangfang Databases and CNKI,from the creation date to December 26,2013,was performed. Two reviewers extracted data independently,and used Reviewer Manager Software（Rev Man 5.2） for statistical analysis. Results Of the 4 716 searching results,10 studies with 2 585 patients were included in the systematic review. The pooling effects of the Meta-analysis showed when comparing to traditional dosing,pharmacogenetic warfarin dosing reduced major bleeding rate during the therapy（RR=0.41,95% CI ： 0.21-0.82）,but no significant advantages were found in international normalized ratio（INR） of time within therapeutic range（TTR） or reduction in thromboembolism rate [TTR（WWD=4.51%,95%CI ：-1.16%-10.18%,P =0.12）; thromboembolism rate（RR =0.52,95% CI： 0.24-1.12,P =0.1）]. Conclusions Based on the current evidence,whether pharmacogenetic warfarin dosing is superior or not is unclear. More randomized controlled trials are still needed.

关 键 词：华法林 基因指导治疗 荟萃分析 

分 类 号：R973.2[医药卫生—药品]