基因检测在指导渝东北地区人工瓣膜术后华法林抗凝的价值  

Value of genetic testing in guiding warfarin anticoagulation after prosthetic heart valve replacement in northeast Chongqing

作　　者：靳云洲 潘仲惠 JIN Yunzhou;PAN Zhonghui(Department of Cardiovascular Surgery,Chongqing University Three Gorges Hospital,Wanzhou404100,China)

机构地区：[1]重庆大学附属三峡医院心脏大血管外科,重庆万州404100

出　　处：《中国现代医生》2022年第7期47-50,共4页China Modern Doctor

摘　　要：目的比较两种华法林剂量预测模式指导用量与实际达标剂量,分析两种预测模式的预测能力,并探讨其临床运用价值。方法随机选取2020年5月至2021年5月在重庆大学附属三峡医院心脏大血管外科就诊的渝东北地区心脏人工瓣膜置换术后并进行基因检测(CYP2C9&VKORC1)的156例病患,按照基因检测结果分为4组,分别为CYP2C9*3 AA组(142例)、CYP2C9*3 AC组(14例)、VKORC1GA(GG)组(25例)、VKORC1AA组(131例)。分别采用两种不同的预测模式(国际华法林药物遗传学协与中国国家卫生健康委员会推荐的两种预测公式)计算出指导用量,然后将其分别与实际达标剂量对比,分析引起差别的因素,并对比两种预测方式的相关性。结果1.国际华法林药物遗传学协推荐公式(方案1)与中国国家卫生健康委员会推荐公式(方案2)预测剂量与实际达标剂量的相关性,方案1(R2=0.606**)高于方案2(R2=0.550**);2.CYP2C9*3 AC组、VKORC1GA(GG)组病例两种预测方案与实际达标剂量相关性不大,方案1相关性分别为(R2=-0.091,R2=0.257),方案2分别为(R2=-0.087,R2=0.304)。3.两种方案预测值及实际达标剂量,CYP2C9*3 AC组用量显著低于CYP2C9*3 AA组(P<0.05)、VKORC1GA(GG)组病患用量显著高于VKORC1AA组(P<0.01)。结论国际预测方案更适合渝东北地区人群,但应警惕突变基因人群的抗凝风险性。Objective To compare the guidance dosage of two warfarin dosage prediction models with the actual compliance dosage,analyze the predictive ability of the two prediction models,and explore their clinical application value.Methods A total of 156 patients underwent genetic testing(CYP2C9&VKORC1)in the Department of Cardiovascular Surgery of Chongqing University Three Gorges Hospital from May 2020 to May 2021 were randomly selected.According to the test results,they were divided into 4 groups:the CYP2C9*3 AA group(n=142),the CYP2C9*3 AC group(n=14),the VKORC1GA(GG)group(n=25),and the VKORC1AA group(n=131).Two different prediction models(two prediction models recommended by the International Warfarin Pharmacogenetics Consortium and the National Health Commission of the People’s Republic of China)were used to calculate the guidance dosage.The guidance dosages were compared with the actual compliance dosages to analyze the factors that caused the difference.The correlation of the two prediction methods were compared.Results The model 1(the model recommended by the International Warfarin Pharmacogenetics Consortium)(R2=0.606)had a higher correlation between the guidance dosage and the compliance dosage than the model 2(the model recommended by the National Health Commission of the People’s Republic of China)(R2=0.550).There were no significant correlations between the guidance dosage and the compliance dosage in the CYP2C9*3 AC group and the VKORC1GA(GG)group in both models(model 1 R2=-0.091 and R2=0.257,and model 2 R2=-0.087 and R2=0.304).The guidance dosages and actual compliance dosages in both models in the CYP2C9*3 AC group were significantly lower than those in the CYP2C9*3 AA group(P<0.05).The guidance dosages and actual compliance dosages in both models in the VKORC1GA(GG)were significantly higher than those in the VKORC1AA group(P<0.01).Conclusion The international prediction model is more suitable for the population in northeast Chongqing,but the risk of anticoagulation in the mutant gene population should

关 键 词：心脏人工瓣膜置换术后 华法林 基因检测 CYP2C9 VKORC1 

分 类 号：R446.1[医药卫生—诊断学]