4种华法林剂量预测模型在心脏瓣膜术后早期患者中的验证与评价  

Verification and Evaluation of 4 Warfarin Dose Prediction Models in Early Patients after Cardiac Valve Surgery

作　　者：苏君[1] 黄慧[2] SU Jun;HUANG Hui(Department of Pharmacy First Affiliated Hospital of Bengbu Medical College)

机构地区：[1]蚌埠医学院第一附属医院药剂科,233004 [2]蚌埠医学院第一附属医院心脏外科

出　　处：《长治医学院学报》2022年第1期31-34,共4页Journal of Changzhi Medical College

基　　金：蚌埠市级科技创新指导类项目(20200339)。

摘　　要：目的:探讨4种华法林剂量预测模型对皖北地区心脏瓣膜术后早期患者华法林剂量预测的准确性。方法:选取54例行心脏瓣膜置换手术使用华法林且进行华法林VKORC1基因和CYP2C9基因型检测的患者,收集并记录患者每天华法林给药剂量、患者性别、身高、年龄、体重、肝肾功能及联合用药等情况。比较患者华法林实际达标剂量与4种模型(指南模型、IWPC模型、Gage模型和WDC模型)预测剂量的准确性。结果:指南模型预测的剂量中位数1.98(四分位数间距0.47)mg显著低于患者实际达标剂量中位数2.50(四分位数间距0.63)mg(P<0.05),预测剂量和实际达标剂量无明显相关性(R=-0.214,P>0.05);IWPC模型预测的剂量中位数3.30(四分位数间距0.95)mg显著高于患者实际达标剂量中位数2.50(四分位数间距0.63)mg(P<0.05),预测剂量与实际达标剂量相关性较高(R=0.548,P<0.05);Gage模型预测的剂量中位数3.10(四分位数间距0.65)mg高于患者实际达标剂量中位数2.50(四分位数间距0.63)mg(P<0.05),预测剂量与实际达标剂量相关性最高(R=0.550,P<0.05);WDC模型预测的华法林剂量中位数2.59(四分位数间距0.91)mg与患者实际达标剂量中位数2.50(四分位数间距0.63)mg差异无统计学意义(P>0.05),而且预测剂量与实际达标剂量相关性较高(R=0.518,P<0.05)。结论:4种模型中WDC模型预测华法林剂量最准确,而且预测剂量和实际达标剂量相关性较高,更适合皖北地区心脏瓣膜置换术后患者华法林剂量预测。Objective:To investigate the accuracy of 4 warfarin dose prediction models for early patients after cardiac valve surgery in northern Anhui.Methods:A total of 54 patients who underwent heart valve replacement surgery in our hospital were selected with warfarin and tested for warfarin VKORC1 gene and CYP2C9 genotype.The daily warfarin dosage,gender and height of the patients,age,weight,liver and kidney function,and combined medication were collected and recorded.The accuracy of the actual target dose of warfarin in patients with the predicted dose of four models(guideline model,IWPC model,Gage model and WDC model)were compared.Results:The median dose predicted by the guideline model was 1.98(interquartile interval 0.47)mg,which was significantly lower than the median dose of actual target dose 2.50(interquartile interval 0.63)mg(P<0.05),and there was no significant correlation between the predicted dose and the actual target dose(R=-0.214,P>0.05).The median dose predicted by IWPC model was 3.30(interquartile interval 0.95)mg,which was significantly higher than the median actual target dose of 2.50(interquartile interval 0.63)mg(P<0.05),although there was a high correlation between the predicted dose and the actual target dose(R=0.548,P<0.05).The median dose predicted by Gage model was 3.10(interquartile interval 0.65)mg,which was higher than the median actual target dose of 2.50(interquartile interval 0.63)mg(P<0.05),although the correlation between the predicted dose and the actual target dose was the highest(R=0.550,P<0.05).There was no significant difference between the median warfarin dose 2.59(interquartile interval 0.91)mg predicted by WDC model and the median actual target dose 2.50(interquartile interval 0.63)mg(P>0.05),and the predicted dose was highly correlated with the actual target dose(R=0.518,P<0.05).Conclusion:Among the four models,the WDC model was the most accurate in predicting the dose of warfarin,and the predicted dose had a high correlation with the actual target dose.Therefore,the WDC model

关 键 词：华法林 剂量预测模型 心脏瓣膜置换术后 

分 类 号：R969[医药卫生—药理学]