基因检测对肺栓塞患者华法林抗凝治疗后国际标准化比值达标时间的影响  

Effect of gene detection on international normalized ratio standard after warfarin anticoagulant therapy in patients with pulmonary embolism

作　　者：白东玉[1,2] 龚娟妮 崔向丽[2,3] BAI Dong-yu;GONG Juan-ni;CUI Xiang-li(Department of Pharmaey,Haigang Hopita,Hebei Qinhuangdae 06600,Chna;Department of Pharmacy,Beijing Friendship Hoptal,Capial Medical University,Beijing 100020,China;Deparment of Respratory and Crical Care Medicne,Beijing Chaoyang Hopitl,Capioal Medical Universit,Beijing,100050,China)

机构地区：[1]河北省秦皇岛市海港医院药学部,河北秦皇岛066000 [2]首都医科大学附属北京友谊医院药学部,北京100020 [3]首都医科大学附属北京朝阳医院呼吸与危重症科,北京100050

出　　处：《临床药物治疗杂志》2020年第12期69-72,共4页Clinical Medication Journal

摘　　要：目的探讨基因监测对肺栓塞患者华法林剂量调整及国际标准化比值(INR)达标时间的影响。方法回顾性分析2017年1月至2018年6月期间于首都医科大学附属北京朝阳医院呼吸科首次华法林抗凝治疗的124例急性肺栓塞患者临床资料,按照是否进行P450酶2C9(CYP2C9)基因和维生素K环氧化物还原酶复合体亚单位1(VKORC1)基因检测分为基因检测组(66例)和基因未检测组(58例)。比较2组患者华法林起始剂量、维持剂量、INR达标天数、住院天数及住院费用。结果CYP2C9基因型为^*1/^*1有62例,^*1/^*3有4例。VKORC1基因型为GA型为12例,GG型为4例,其余50例为野生AA型。2组患者华法林起始剂量、维持剂量、INR达标天数、住院天数和住院费用差异均无统计学意义(P>0.05)。CYP2C9^*1/^*1型、VKORC1 GA型患者华法林起始剂量显著高于CYP2C9^*1/^*1、VKORC1 AA型(P=0.002),INR达标天数也显著延长(P=0.008),CYP2C9^*1/^*1型、VKORC1 GA型患者华法林维持剂量显著高于CYP2C9^*1/^*1、VKORC1 AA型及CYP2C9^*1/^*3、VKORC1 AA型(P<0.05)。结论对服用华法林的急性肺栓塞患者进行基因检测并不能减少INR达标天数、住院天数和住院费用,73.5%的患者为CYP2C9^*1/^*1、VKORC1 AA型,除患者通过常规剂量调整难以INR达标外,不建议常规进行CYP2C9和VKORC1基因检测。Objective To investigate whether warfarin dose adjustment and days to reach the target range of international normalized ratio(INR)can be affected by gene detection in patients with pulmonary embolism.Methods The clinical data of124 acute pulmonary embolism patients treated with warfarin for the first time in the Department of Respiratory Medicine,Beijing Chaoyang Hospital,Capital Medical University,from January 2017 to June 2018 were retrospectively analyzed.According to whether P450 enzyme 2 C9(CYP2 C9)gene and vitamin K epoxide reductase complex subunit 1(VKORC1)gene detection was performed,divided into gene detection group(66 cases)and gene undetected group(58 cases).The initial dose of warfarin,maintenance dose,INR compliance days,hospitalization days,and hospitalization expenses of the two groups were compared.Results The CYP2 C9 genotype was^*1/^*1 with 62 cases and^*1/^*3 with 4 cases.There were 12 cases of VKORC1 genotype of GA type,4 cases of GG type,and the remaining 50 cases of wild AA type.There were no notably differences in the initial dose of warfarin,maintenance dose,INR compliance days,hospitalization days,and hospitalization expenses between the two groups(P>0.05).The initial dose of warfarin in CYP2 C9^*1/^*1 and VKORC1 GA type patients was significantly higher than that of CYP2 C9^*1/^*1,VKORC1 AA type(P=0.002),and the INR compliance days were also obviously longer(P=0.008).The warfarin maintenance dose of CYP2 C9^*1/^*1,VKORC1 GA type patients,was apparently higher than CYP2 C9^*1/^*1,VKORC1 AA type and CYP2 C9^*1/^*3,VKORC1 AA type(P<0.05).Conclusion Genetic testing for patients with acute pulmonary embolism taking warfarin does not reduce the number of INR compliance days,hospitalization days and hospitalization costs.There is 73.5%of patients are the type of CYP2 C9^*1/^*1,VKORC1 AA.Except for patients having difficulties in reaching the standard of INR through regular dose adjustment,it is not recommended to perform routinely CYP2 C9 and VKORC1 genetic testing.

关 键 词：肺栓塞 华法林 基因多态性 

分 类 号：R563.5[医药卫生—呼吸系统]