CYP2C9 VKORC1基因多态性指导对非瓣膜性心房颤动患者华法林剂量的影响

目的 探讨CYP2C9、VKORC1基因多态性对非瓣膜性心房颤动（NVAF）患者华法林应用剂量的影响。方法 选择合肥市第二人民医院2017年11月至2019年10月收治的214例NVAF患者，采用随机数字表法分为基因指导组（69例）与对照组（145例），基因指导组检测VKORC1、CYP2C9基因多态性，对照组按常规剂量给予华法林，比较两组患者华法林起效剂量、有效剂量、起效时间及第14、21天达稳定剂量患者比例等指标。结果 基因指导组患者在华法林应用初始剂量为（1.67±1.63）mg、稳定剂量为（2.02±0.94）mg，均低于对照组，起效时间为（7.62±2.87）d，短于对照组短，差异有统计学意义（P<0.05）。CYP2C9、VKORC1组华法林应用初始剂量、稳定剂量均低于对照组，起效时间短于对照组，差异有统计学意义（P<0.05）。基因指导组第14、21天达稳定剂量患者比例（76.44%、98.27%）高于对照组，差异有统计学意义（P<0.05）。结论 VKORC1、CYP2C9基因多态性检测结合NVAF患者临床特点可为临床精准合理应用华法林提供参考。

Influence of CYP2C9 and VKORC1 genetic polymorphism on guiding anticoagulant therapy of warfarin in patients with nonvalvular atrial fibrillation

Objective It is to analyze the influence of CYP2C9 and VKORC1 genetic polymorphism on anticoagulant therapy of warfarin in nonvalvular atrial fibrillation patients in Hefei area. Methods 214 patients with nonvalvular atrial fibrillation admitted to Hefei Second People''s Hospital from November 2017 to October 2019 were randomly recruited and divided into experimental group (69 cases) and control group(145 cases).The CYP2C9 and VKORC1 genetic polymorphism of experimental group were detected. Experimental group was given warfarin at the recommended dose according to the test results, while the control group was given at regular dose. The initial dose, effective dose, onset time, and effective dose compliance rates of 14th and 21th days of warfarin were compared. Results The initial dose(1.67±1.63) mg, effective dose(2.02±0.94) mg of experimental group was significantly lower than the control group(P<0.05), effective dose compliance rates of 14th and 21th days(76.44%)(98.27%) was significantly higher than the control group (P<0.05). Conclusion The detection of CYP2C9 and VKORC1 genetic polymorphism combined with the clinical setting of patients provided evidence for using genotype to guide warfarin dose in clinic.