初始国际标准化比值预测华法林抗凝强度的试验性评价  

Test evaluation of predicting the anticoagulant intensity of warfarin with initial international normalized ratio

作　　者：许海江[1] 赵春玲[1] 杨彦涛 贾雪冬 Xu Haijiang;Zhao Chunling;Yang Yantao;Jia Xuedong(Department of Pharmacy,The First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院药学部,450052

出　　处：《国际医药卫生导报》2020年第21期3253-3256,共4页International Medicine and Health Guidance News

摘　　要：目的评价初始国际标准化比值(INR)预测华法林治疗患者抗凝强度的效能,为临床用药提供帮助。方法回顾性纳入华法林治疗(2.5 mg/d,连续口服7 d)住院患者137例,分别于用药3 d和7 d时监测INR。Pearson相关分析3 d时INR(INR初始)与7 d时INR(INR7 d)的相关性;受试者工作特征曲线(ROC)评价INR初始预测服华法林7 d时患者不同抗凝强度的能力。结果(1)INR初始和INR7 d分别为(1.66±0.42)和(2.28±0.65),二者呈显著正相关(r=0.785,P<0.001)。(2)服用华法林7 d时未达抗凝强度(INR<1.5)者12例,低抗凝强度(1.5≤INR<2.0)者33例,标准抗凝强度(2.0≤INR≤3.0)者80例,高抗凝强度(INR>3.0)者12例。(3)INR初始预测7 d时患者≥低抗凝强度、≥标准抗凝强度和高抗凝强度的AUC分别为0.789、0.801和0.899,与随机面积0.5比较,P<0.01。(4)当INR初始1.388作为最佳截断值时(Youden指数最大),预测患者≥低抗凝强度的敏感性、特异性和符合率分别为0.744、0.750和74.45%;当INR初始1.595作为截断值时,预测患者≥标准抗凝强度的敏感性、特异性和符合率分别为0.652、0.822和70.80%;当INR初始1.905作为截断值时,预测患者达高抗凝强度的敏感性、特异性和符合率分别为0.857、0.829和83.21%。结论INR初始预测服用华法林患者不同抗凝强度的能力较好,可作为临床用药的重要参考指标,当INR初始<1.388或INR初始>1.905者,应进行剂量调整。Objective To evaluate the effectiveness of the initial international normalized ratio(INR)in predicting the anticoagulant intensity of warfarin in patients,and to provide assistance for clinical medication.Methods 137 inpatients treated with warfarin(2.5 mg/d,continuous oral administration for 7 days)were retrospectively included,and the INR was monitored on the 3rd and 7th day,respectively.Pearson correlation analysis was used to analyze the correlation between INR on the 3rd day(INRinitial)and INR on the 7th day(INR7 d).The receiver operating characteristic curve(ROC)was used to evaluate the ability of INRinitial in predicting the anticoagulant intensity of patients taking warfarin on the 7th day.Results(1)The INRinitial and INR7 d were(1.66±0.42)and(2.28±0.65),and the two were significantly positively correlated(r=0.785,P<0.001).(2)12 patients did not reach the anticoagulant intensity(INR<1.5)after taking warfarin for 7 days,there were 33 cases of low anticoagulant intensity(1.5≤INR<2.0),80 cases of standard anticoagulant intensity(2.0≤INR≤3.0),and 12 cases of high anticoagulant intensity(INR>3.0).(3)The AUC of INRinitial in the prediction of patients with≥low anticoagulant intensity,≥standard anticoagulant intensity,and high anticoagulant intensity on the 7th day were 0.789,0.801,and 0.899,P<0.01 compared with random area 0.5.(4)When the INRinitial 1.388 as the best cut-off value(Youden index was the biggest),the sensitivity,specificity,and coincidence rate of patients predicted to be≥low anticoagulant intensity were 0.744,0.750,and 74.45%;when the INRinitial 1.595 as the cut-off value,the sensitivity,specificity,and coincidence rate of patients predicted to be≥standard anticoagulant intensity were 0.652,0.822,and 70.80%;when the INRinitial 1.905 as the cut-off value,the sensitivity,specificity,and coincidence rate of patients predicted to be high anticoagulant intensity were 0.857,0.829,and 83.21%.Conclusion The initial INR has a good ability in predicting the anticoagulant intensity of patie

关 键 词：华法林 抗凝治疗 国际标准化比值 受试者工作特征曲线 个体化给药 

分 类 号：R563.9[医药卫生—呼吸系统]