基于基因型检测的药学干预对住院患者应用华法林疗效和安全性的影响

目的：探讨基于基因型检测的药学干预对住院患者应用华法林疗效和安全性的影响。方法收集2013年6月至2014年3月在北京大学第一医院住院并根据细胞色素P450（CYP）2C9＊2、CYP2C9＊3、维生素K环氧化物还原酶复合物1（VKORC1）G-1639A基因型检测结果调整华法林剂量患者（试验组）和2012年6至12月应用华法林但未进行基因型检测患者（对照组）的病历资料进行回顾性分析，比较2组患者的住院时间、服用华法林时间、国际标准化比值（ INR）曾出现≥3.0者占比、华法林相关出血发生率、出院时INR和出院时华法林剂量，对试验组患者分析出院时华法林剂量与临床药师给予的华法林建议剂量的相关性，并分析试验组患者上述指标与基因型的相关性。结果试验组102例，男性62例，女性40例，年龄14-88岁，平均（63±16）岁。对照组140例，男性89例，女性51例，年龄21-85岁，平均（64±13）岁。原发疾病包括心房颤动、深静脉血栓、肺栓塞和肾静脉血栓等。2组患者年龄和性别分布差异均无统计学意义。试验组平均住院时间和服用华法林时间明显长于对照组（16.7±8.4）d比（12.6±6.0）d，（13.2±8.2）d比（9.9±6.1）d，均P＆lt;0.001]。2组中INR≥3.0者占比、华法林相关出血发生率、出院时INR的差异均无统计学意义。试验组携带CYP2C9＊1/＊3者（7例）出院时华法林剂量低于携带CYP2C9＊1/＊1者（95例）（1.79±0.57）mg/d比（3.12±1.13）mg/d，P=0.003]；携带VKORC1-1639 GG者（1例）和VKORC1-1639GA者（20例）出院时华法林剂量均高于携带VKORC1-1639AA者（81例）6.00、（3.55±1.63）mg/d 比（2.87±0.92） mg/d，P=0.002]。试验组INR≥3.0者住院时间和服用华法林时间均多于INR＆lt;3.0者（24.7±10.9）d比（15.2±6.9）d，（21.8±10.9）d比（11.6±6.4）d，均P＆lt;0.001]，出院时华法林剂量低于INR＆lt;3.0者（2.50±1.02）mg/

Effects of pharmaceutical intervention based on genotype detection on curative effect and safety in hospitalized patients receiving warfarin

Objective To explore the effects of pharmaceutical intervention based on genotype detection on curative effect and safety in hospitalized patients receiving warfarin. Methods The medical records of patients hospitalized in the Department of Cardiology,First Hospital of Peking University whose dosages of warfarin were adjusted according to the results of CYP2C9＊2,CYP2C9＊3,vitamin K epoxide＆amp;nbsp;reductase complex subunit （ VKORC1 ）G-1639A genotype testing from June 2013 to March 2014 （ experimental group ） and the patients received warfarin but did not carry the genotype testing（ control group）from June to December 2012 were collected and analyzed retrospectively. The length of hospital stay, administration time of warfarin,proportion of patients whose international normalized ratio（INR）≥3. 0 had happened,incidence of bleeding associated with warfarin,INR values and warfarin dosage on discharging were compared between the patients in the two groups. The correlation of warfarin dosage on discharging and the suggested dosage proposed by clinical pharmacist,the above-mentioned parameters and the genotype in the experimental group were analyzed. Results There were 102 patients in the experimental group comprised 62 male and 40 female with average age of（63 ± 16）years（14-88）. There were 140 patients in the control group comprised 89 male and 51 female with average age of（ 64 ± 13 ） years（ 21-85 ）. The patients＆#39;primary diseases included auricular fibrillation,deep vein thrombosis,pulmonary embolism and renal vein thrombus,etc. There were no statistically significant difference between age and sexual distinction in the 2 groups. The average length of hospital stay and average administration time of warfarin in patients in the experimental group were obviously longer than those in the control group（16. 7 ± 8. 4）d vs.（12. 6 ± 6. 0）d,（13. 2 ± 8. 2）d vs. （9. 9 ± 6. 1）d,all P 〈0. 001]. There were no statistically significant difference of the proportion