高龄非瓣膜性心房颤动患者遗传多态性与利伐沙班出血事件风险的相关性  

Correlation of genetic polymorphisms with risk of rivaroxaban-associated bleeding events in very old patients with nonvalvular atrial fibrillation

作　　者：李鹏[1] 梁存禹 丁欢欢 王娟[1] Li Peng;Liang Cunyu;Ding Huanhuan;Wang Juan(Department of Cardiology,the Fifth Affiliated Hospital of Xinjiang Medical University,Urumqi 830011,Xinjiang Uygur Autonomous Region,China)

机构地区：[1]新疆医科大学第五附属医院心内科,乌鲁木齐830011

出　　处：《中华老年心脑血管病杂志》2024年第7期755-758,共4页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基　　金：省部共建中亚高发病成因与防治国家重点实验室开放课题项目(SKL-HIDCA-2020-JZ5);新疆医科大学2024年科研创新团队项目(XYD2024C11)。

摘　　要：目的 探讨高龄非瓣膜性心房颤动患者遗传多态性与利伐沙班出血事件风险的相关性。方法 选取2019年6月至2022年6月于新疆医科大学第五附属医院心内科就诊的老年非瓣膜性心房颤动患者180例,所有患者均服用利伐沙班,随访1年,最终纳入167例,根据患者是否发生出血事件分为出血组31例和对照组136例。比较2组患者临床资料和遗传多态性,采用多因素logistic回归分析遗传多态性与高龄非瓣膜性心房颤动患者服用利伐沙班发生出血事件的相关性。结果 出血组细胞色素氧化酶2C9(CYP2C9)*1、CYP2C9*3、维生素K环氧化物还原酶复合体1(VKORC1)-GG频率高于对照组,CYP2C9*2、VKORC1-AA、VKORC1-AG频率低于对照组(P<0.01)。多因素logistic回归分析显示,CYP2C9*1、CYP2C9*3、VKORC1-GG是高龄非瓣膜性心房颤动患者服用利伐沙班发生出血事件的独立危险因素(OR=1.880,95%CI:1.126~1.997,P=0.030;OR=1.432,95%CI:1.044~1.964,P=0.026;OR=2.176,95%CI:1.173~4.037,P=0.014),CYP2C9*2、VKORC1-AA、VKORC1-AG是高龄非瓣膜性心房颤动患者服用利伐沙班发生出血事件的保护因素。结论 CYP2C9和VKORC1遗传基因的多态性与高龄非瓣膜性心房颤动患者服用利伐沙班发生出血事件显著相关,其中CYP2C9*1、CYP2C9*3、VKORC1-GG基因型是独立危险因素,CYP2C9*2、VKORC1-AA、VKORC1-AG基因型则是保护因素。Objective To investigate the correlation between genetic polymorphisms and the risk of rivaroxaban bleeding events in elderly patients with nonvalvular atrial fibrillation(NVAF).Methods A total of 180elderly NVAF patients treated with rivaroxaban in our department from June 2019to June 2022were enrolled,and after 1year of follow-up,finally,167patients were included,according to whether bleeding events occurred,they were divided into hemorrhage group(n=31)and control group(n=136).The clinical data and genetic polymorphism were compared between the two groups.Multivariate logistic regression was used to analyze the association between genetic polymorphisms and bleeding events in the patients after rivaroxaban treatment.Results Higher frequencies of CYP2C9*1,CYP2C9*3and VKORC1-GG,but lower frequencies of CYP2C9*2,VKORC1-AA and VKORC1-AG were observed in the bleeding group than the control group(all P<0.01).Multivariate logistic regression analysis showed that CYP2C9*1,CYP2C9*3and VKORC1-GG were independent risk factors for bleeding events in elderly NVAF patients taking rivaroxaban(OR=1.880,95%CI:1.126-1.997,P=0.030;OR=1.432,95%CI:1.044-1.964,P=0.026;OR=2.176,95%CI:1.173-4.037,P=0.014),while,CYP2C9*2,VKORC1-AA and VKORC1-AG were protective factors for bleeding events in elderly NVAF patients taking rivaroxaban.Conclusion Genetic polymorphisms of CYP2C9and VKORC1are significantly correlated with the risk of bleeding events in elderly NVAF patients taking rivaroxaban.And CYP2C9*1,CYP2C9*3 and VKORC1-GG genotypes are independent risk factors,while CYP2C9*2,VKORC1-AA and VKORC1-AG genotypes are protective factors.

关 键 词：心房颤动 基因型 利伐沙班 出血 CYP2C9基因多态性 VKORC1基因多态性 

分 类 号：R541.75[医药卫生—心血管疾病]