VKORC1和CYP2C9基因多态性对ICU患者华法林抗凝治疗的指导价值OACSTPCD
Guiding value of VKORC1 and CYP2C9 gene polymorphisms on anticoagulation treat-ment of warfarin in ICU patients
目的 探讨重症监护室(ICU)患者中,维生素K环氧化物还原酶复合体亚单位 1(VKORC1)和细胞色素氧化酶P450 2C9(CYP2C9)基因多态性检测对华法林抗凝治疗的指导价值.方法 回顾性分析 2019-06 至 2023-06 火箭军特色医学中心ICU收治的合并抗凝指征(心房颤动、深静脉血栓、肺栓塞)患者 90 例.研究组(30 例)为进行基因检测并根据检测结果指导华法林用药的患者;对照组(60 例)为未进行基因检测执行临床常规华法林用药策略的患者,对两组进行为期 6 个月的随访.比较两组一般临床资料信息、研究组基因型分布情况、国际标准化比值(INR)达标时间、治疗窗内的时间比例(TTR)、华法林起始及维持剂量、出血事件发生率及INR≥4.0 事件发生率.结果 研究组INR达标时间(9.56±1.68)d,短于对照组的(11.12±2.03)d;研究组TTR为(72.56±6.90)%,高于对照组 的(64.45±7.82)%,差异有统计学意义(P<0.05).研究组华法林起始和维持剂量分别为(2.91±0.73)mg/d、(3.17±0.81)mg/d,与对照组相比差异均无统计学意义.研究组中小出血事件发生 6 例(20.00%),低于对照组的 27 例(45.00%),差异有统计学意义(P<0.05),两组大出血事件发生率差异无统计学意义.研究组INR≥4.0 发生率为 16.67%,低于对照组的 40.00%,差异有统计学意义(P<0.05).结论 ICU合并抗凝指征患者进行VKORC1 和CYP2C9 基因多态性检测指导华法林用药,有利于增强抗凝疗效、减少相关不良反应,进而提高用药安全性.
Objective To investigate the guiding value of vitamin K epoxide reductase complex subunit 1(VKORC1)and cy-tochrome oxidase P450 2C9(CYP2C9)gene polymorphism detection on anticoagulation therapy of warfarin in intensive care unit(ICU)patients.Methods Ninety patients with indication of anticoagulation(atrial fibrillation,deep vein thrombosis and pulmonary embolism)admitted to ICU of Characteristics Medical Center of PLA Rocket Force from June 2019 to June 2023 were retrospectively analyzed.The study group(30 cases)underwent genetic testing and were instructed to use warfarin based on the test results,while the control group(60 cases)implemented the conventional clinical warfarin medication strategy without genetic testing.Both groups were followed up for 6 months.The general clinical data,genotype distribution of the study group,INR attainment time,time in treatment range TTR,warfarin starting dose,maintenance dose,incidence of bleeding events and incidence of INR≥4.0 events were compared between the two groups.Results The time to achieve INR in the study group was(9.56±1.68)d,which was significantly shorter than that in the control group(11.12±2.03)d,P<0.05.The TTR in the study group was(72.56±6.90)%,which was higher than that in the control group(64.45±7.82)%,P<0.05.The starting and maintenance doses of warfarin in the study group were(2.91±0.73)mg/d and(3.17±0.81)mg/d,respectively,which were not statistically different from those in the control group(P>0.05).There were six cases(20.00%)of small bleeding events in the study group,which was significantly lower than that in the control group(twenty-seven cases,45.00%,P<0.05).In contrast,there was no significant difference in the incidence of major bleeding events between the two groups(P>0.05).The incidence of INR≥4.0 in the study group was 16.67%,significantly lower than that in the control group(40.00%,P<0.05).Conclusions Detection of VKORC1 and CYP2C9 polymorphisms in ICU patients with indica-tion of anticoagulation is beneficial to enhance anticoagulation efficacy,reduce related adverse reactions,and improve drug safety.
闫斌;张梅;赵贵锋
100088 北京,火箭军特色医学中心:重症医学科100088 北京,火箭军特色医学中心:妇产科100088 北京,火箭军特色医学中心:重症医学科
药学
重症监护室华法林基因多态性CYP2C9VKORC1抗凝治疗
intensive care unitwarfaringene polymorphismCYP2C9VKORC1anticoagulation therapy
《武警医学》 2024 (10)
853-856,4
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