非瓣膜病房颤患者VKORC1与CYP2C9基因多态性华法林抗凝剂量模型临床疗效评价

目的：验证非瓣膜病房颤患者运用VKORC1与CYP2C9基因多态性华法林抗凝剂量模型的有效性与可行性,以探求华法林个体化临床应用,缩短达标时间,提高该药使用率与依从性。方法：选择沈阳医学院附属第二医院心血管内科住院治疗非瓣膜性房颤患者分为模型组与经验组,两组各60例,记录基线资料,并提取空腹静脉血检测VKORC1-1639与CYP2C9基因多态性。模型组患者日剂量根据既定公式计算所得给予华法林片,经验组根据医师临床用药经验及体重给予起始剂量。随访6个月,记录达稳定剂量时间,INR达标时间,计算INR在治疗目标范围内的时间百分比(TTR)。结果：两组需要服用华法林进行抗凝治疗的患者基线指标比较差异无统计学意义 (P>0.05)。模型组预测剂量与实际剂量较为接近,有63%的患者未调整剂量,该比例明显高于经验组,达稳态维持剂量时间亦短于经验组,同时模型组INR达标时间较短。此外模型组TTR＞60%患者为39例(53.4%),而经验组为28例(37.3%)。结论：利用针对中国人群的基于VKORC1与CYP2C9基因多态性华法林抗凝剂量模型对非瓣膜病房颤患者进行华法林起始及稳定剂量预测,模型的预测准确性可达60%以上。该模型具有一定的临床实用价值。

Evaluation of clinical efficacy in patients with nonvalvular atrial fibrillation VKORC1 and CYP2C9 gene polymorphism warfarin anticoagulation dose modelZhang Xiao-Dan,Zhao Hong-Li, Li-Lu ,Zhou jia-meng,Wang xiao-xin,Wang xiao-xi.Department of Cardiology,the Second Affiliated Hospital of Shenyang Medical College.

Objective To verify the feasibility and effectiveness of non valvular atrial fibrillation patients by VKORC1 and CYP2C9 gene polymorphism warfarin anticoagulation dose model,To explore the clinical application of warfarin individual, reduce the standard time, improve the drug use rate and compliance.Methods To select the model group and experience group for the treatment of patients with non valvular atrial fibrillation in the Second Affiliated Hospital of Shenyang Medical College,each groups had 60 patients,Record baseline data,VKORC1-1639 and CYP2C9 gene polymorphisms were detected in the fasting venous blood.The model groups were calculated according to the established daily dose given warfarin tablets,According to the clinical experience of physicians and the starting dose of weight.Follow up for 6 months, and record the time of stable dose.INR standard time,To calculate the percentage of time in the target range of INR(TTR).Results The two groups need to take warfarin to carry on the comparison of the baseline parameters of the patients with anticoagulant therapy has no statistical significance(P>0.05),The model group was close to the actual dose.63% of patients did not adjust dosage,The proportion was significantly higher than that of the experience group,Up to the stable maintenance dose time is shorter than that of the experience group,At the same time, the INR standard time of the model group was shorter .In addition, the model group TTR > 60% patients were 39 cases(53.4%),the experience group was 28 cases(37.3%).Conclusion With the Chinese population based on VKORC1 and CYP2C9 gene polymorphisms of warfarin anticoagulant dose model in patients with non valvular atrial fibrillation (AF) of warfarin initiation and stable dose prediction,The accuracy of the model is more than 60%.The model has a certain clinical practical value.