华法林药物基因检测指导抗凝治疗124例临床分析  

Clinical analysis of Warfarin in guidance of gene testing on 124 cases of anticoagulation therapy

作　　者：胡学俊[1] 方存明 黄政[1] 后世祥 HU Xuejun;FANG Cunming;HUANG Zheng;HOU Shixiang(Department of Cardiology,People's Hospital of Xuancheng,Xuancheng,Anhui 242000,China;Department of Pharmacy,People's Hospital of Xuancheng,Xuancheng,Anhui 242000,China)

机构地区：[1]安徽省宣城市人民医院心内科,242000 [2]安徽省宣城市人民医院药学部,242000

出　　处：《重庆医学》2020年第10期1631-1634,1638,共5页Chongqing medicine

基　　金：安徽省宣城市级科技计划项目(1817)。

摘　　要：目的评价药物基因检测指导华法林抗凝治疗的临床应用价值。方法将124例患者分为基因型引导给药组和传统给药组,基因型引导给药组根据基因型、年龄、身高、体质量等因素接受定制剂量,传统给药组根据临床惯例使用华法林,主要观察华法林治疗后12周内,国际标准化比值(INR)在治疗范围1.8~3.0的时间百分比和过度抗凝发生率、过低INR值发生率、达到治疗INR值所需时间、达到稳定华法林剂量所需时间及血栓和出血事件的差异。结果基因型引导给药组在治疗3个月内INR在1.8~3.0的时间百分比为(67.2±16.8)%,传统给药组为(59.3±17.8)%,有7.9%的差异(95%CI:4.9%~8.9%,P<0.01);基因型引导给药组出现INR值高于3.5的患者数和持续时间均低于传统给药组,INR值低于1.8的持续时间低于传统给药组;基因型引导给药组达到治疗性INR的中位时间少于传统给药组,达到稳定INR时间少于传统给药组;两组间出血事件和血栓栓塞事件差异无统计学意义。结论基因型引导给药组在主要观察指标和次要观察指标方面均优于传统给药组,可能使抗凝治疗更有效、更安全。Objective To evaluate the clinical application value of Warfarin therapy guided by gene testing.Methods A total of 124 patients were randomly divided into the genotype-guided group and the traditional group.In the genotype-guided group,Warfarin doses were prescribed according to the genotype,age,height,weight.In the traditional group,Warfarin doses were administered according to clinical practice.The difference on percentage of time in therapeutic range 1.8-3.0 for the international standardization ratio(INR),the incidence of excessive anticoagulation,the incidence of low INR,the time to achieve therapeutic INR,the time to achieve stable Warfarin dose,thrombosis and bleeding events were observed during 12 weeks after Warfarin therapy.Results The percentage of time in therapeutic range 1.8-3.0 for INR in the genotype-guided group was(67.2±16.8)%,and(59.3±17.8)%in the traditional group,with a difference of7.9%(95%CI:4.9%-8.9%,P<0.01).The number of patients and duration with INR higher than 3.5 in the genotype-guided group were lower than those in the traditional group,and the duration of INR lower than1.8 was lower than that in traditional group.The median time to reach therapeutic INR in the genotype-guided group was less than that in the traditional group,and the time to reach stable INR was less than that in the traditional group.There was no significant difference in bleeding events and thromboembolic events between the two groups.Conclusion The genotype-guided group is superior to the traditional group in terms of main and secondary observation indexes,and genotype-guided administration may make Warfarin therapy more effective and safe.

关 键 词：抗凝药 华法林 基因检测 

分 类 号：R972[医药卫生—药品]