VKORC1和CYP2C9基因多态性对老年心房颤动患者华法林抗凝治疗的指导价值  

Value of VKORC1 and CYP2C9 polymorphisms in guiding anticoagulation therapy of warfarin in elderly patients with atrial fibrillation

作　　者：吴溧兴[1] 童黄锦[1] 高昕[1] 阎芹[1] 胡政力[1] 沈建平[1] 朱志仑 WU Lixing;TONG Huangjin;GAO Xin(Department of Cardiovascular Medicine,Affiliated Hospital of Integrated Chinese and Western Medicine,Nanjing University of Chinese Medicine,Nanjing 210028,CHINA)

机构地区：[1]南京中医药大学附属中西医结合医院心血管科,江苏210028 [2]南京市溧水区中医院心血管科

出　　处：《江苏医药》2019年第10期998-1000,共3页Jiangsu Medical Journal

基　　金：江苏省中医药局科技项目(FY201806)

摘　　要：目的探讨维生素K环氧化物还原酶复合体亚单位1(VKORC1)和细胞色素P450酶2C9(CYP2C9)基因多态性对老年心房颤动(房颤)患者华法林抗凝治疗的指导意义。方法老年房颤患者60例随机均分为基因指导组和常规治疗组。基因指导组在检测VKORC1和CYP2C9基因多态性后根据计算量使用华法林,常规治疗组给予华法林5mg/d负荷剂量。凝血国际标准化比率(INR)目标值定为2≤INR≤3,随访3个月,比较两组华法林达标剂量、抗凝达标时间和不良事件发生情况。结果基因指导组华法林达标剂量与常规治疗组相仿[(2.77±1.29)mg/d vs.(2.52±0.68)mg/d](P>0.05),而基因指导组抗凝达标时间短于常规治疗组[(15.63±3.14)d vs.(18.83±4.97)d](P<0.05);随访期内,基因指导组INR>4的人次少于常规治疗组(P<0.05),而两组抗凝期间并发出血人次相仿(P>0.05)。结论依据VKORC1和CYP2C9基因多态性检测结果指导华法林抗凝治疗可以缩短华法林抗凝达标时间。Objective To investigate the value of vitamin K epoxide reductase complex 1(VKORC1)and 2 C9 of cytochrome P450 system(CYP2 C9)polymorphisms in guiding anticoagulation therapy of warfarin in elderly patients with atrial fibrillation(AF).Methods Sixty elderly patients with AF were randomly divided into two groups with 30 cases each.The target value of international standardized ratio(INR)was 2≤INR≤3 during anticoagulation therapy of warfarin in three months.The gene-guided anticoagulation therapy of warfarin was performed in group A,which was on the basis of detection of VKORC1 and CYP2 C9 gene polymorphisms.The conventional warfarin treatment with a loading dose of warfarin 5 mg/d was performed in group C.The dosage of warfarin and the time reaching a target value of INR and relevant adverse events were compared between two groups.ResultsThe target dosage of warfarin reached a target value of INR in group A was similar to that in group C[(2.77±1.29)mg/day vs.(2.52±0.68)mg/day](P>0.05),but the time reaching a target value of INR in group A was shorter than that in group C[(15.63±3.14)days vs.(18.83±4.97)days](P<0.05).During three months of anticoagulation therapy of warfarin,the number of the case with INR>4 was less in group A than that in group C(P<0.05),but there was no difference in bleeding events between two groups(P>0.05).Conclusion The warfarin anticoagulant therapy guided by VKORC1 and CYP2 C9 gene polymorphism detection can shorten the time reaching a target value of INR.

关 键 词：心房颤动 华法林 基因多态性 维生素K环氧化物还原酶复合体亚单位1 细胞色素P450酶2C9 老年 

分 类 号：R541[医药卫生—心血管疾病]