炎症基因型指导的华法林给药与机械心脏瓣膜置换术疗效的关系  

Relationship between warfarin administration guided by inflammation genotypes and curative effect of mechanical heart valve replacement surgery

作　　者：韩小虎[1] 李儒正[1] 孙鹤宁 Han Xiaohu;Li Ruzheng;Sun Hening(Department of Cardiac Surgery,Hainan Affiliated Hospital of Hainan Medical University,Haikou 570300,China;不详)

机构地区：[1]海南省人民医院/海南医学院附属海南医院心脏外科,海口570300

出　　处：《中国循证心血管医学杂志》2024年第5期569-572,共4页Chinese Journal of Evidence-Based Cardiovascular Medicine

基　　金：海南省卫生健康行业科研项目(22A200236)。

摘　　要：目的探讨炎症基因型指导的华法林给药与机械心脏瓣膜置换术疗效的关系。方法选择2020年1月至2023年7月于海南省人民医院心脏外科接受心脏瓣膜置换术并拟行华法林抗凝治疗的91例患者。使用分层区组随机化将患者分配到基于细胞色素P450亚家族IIC多肽9(CYP2C9)与维生素K环氧化物还原酶复合物亚基1(VKORC1)基因型加/不加炎症基因型的给药组。主要结局为治疗范围内时间百分比(pTTR),包括开始华法林治疗后第1周、住院期间和直至第一次门诊就诊。结果共42例接受基于CYP2C9与VKORC1基因型加炎症基因型指导的华法林剂量治疗,49例接受不加炎症基因型指导的剂量治疗。基于CYP2C9与VKORC1基因型不加炎症基因型给药组和加炎症基因型给药组患者的基因型频率无显著差异(P>0.05)。与不加炎症基因型给药组相比,加炎症基因型给药组pTTR均有升高的趋势,但无统计学意义(P>0.05)。进一步进行亚组分析,在主动脉瓣亚组中,与不加炎症基因型给药组相比,加炎症基因型给药组患者治疗后第1周、住院期间、直到第一次门诊就诊的pTTR值均显著升高(P<0.05)。但在二尖瓣亚组和其他瓣膜置换术亚组患者中,不加炎症基因型给药组和加炎症基因型给药组患者的pTTR均无显著差异(P>0.05)。结论炎症基因型指导的华法林给药可能有益于接受机械主动脉瓣置换术的患者。Objective To discuss the relationship between warfarin administration guided by inflammation genotypes and curative effect of mechanical heart valve replacement surgery.Methods The patients(n=91)undergone heart valve replacement surgery and scheduled to receive warfarin anticoagulant therapy were chosen from Department of Cardiac Surgery in People's Hospital of Hainan Province from Jan.2020 to July 2023.All patients were divided,by using stratified block randomized,into inflammation genotype group and noninflammation genotype group based on the genotypes ofrecombinant cytochrome P4502C9(CYP2C9)and vitamin K epoxide reductase complex subunit 1(VKORC1).The primary outcome was percentage of time in therapeutic range(pTTR),including the first week after beginning warfarin therapy,during hospitalization and up to the first outpatient visit.Results There were 42 patients in inflammation genotype group and 49 in non-inflammation genotype group.There was no significant difference in genotype frequency between in flammation genotype group and noninflammation genotype group(P>0.05).The value of pTTR had an ascending trend in inflammation genotype group compared with non-inflammation genotype group,but there was no statistical significance(P>0.05).The subgroup analysis showed that value of pTTR increased significantly during the first week after beginning warfarin therapy,during hospitalization and up to the first outpatient visit in inflammation genotype group compared with noninflammation genotype group in aortic valve replacement subgroup(P<0.05).The value of pTTR had no significant difference between inflammation genotype group and non-inflammation genotype group in mitral valve replacement subgroupand other valve replacement subgroups(P>0.05).Conclusion The warfarin administrationguided by inflammation genotypes may be beneficial to patients undergone mechanical aortic valve replacement.

关 键 词：炎症基因型 华法林 机械主动脉瓣置换术 疗效 

分 类 号：R0[医药卫生]