摘要
目的:近年来不断有华法林个体化剂量预测公式提出,但仍不能解释相当一部分的个体化差异,究其原因,可能与剂量影响因素纳入不够全面有关。因此,有必要对纳入因素作进一步归纳,并从中整理和筛选出一套可靠的剂量影响因素。方法:本研究分别从基因、合并用药、合并疾病、国际标准化比值(INR)以及手术因素逐条分析了华法林剂量的影响因素及其研究依据。结果:最终建议纳入的因素有如下几类:(1)CYP4F2基因;(2)单独纳入那些应用较广泛或已被其他公式验证的药物,而其他的人群应用不广泛的或者对华法林影响尚未明确的药物则可以用合并用药数目来表示;(3)肝功能、肾功能、心功能,发热状态、白细胞水平等因素;(4)吸烟饮酒史、肺动脉和深静脉栓塞史;(5)每日的维生素K摄入量;(6)研究华法林给药早期剂量或者单日剂量时,建议纳入前几日的INR值和术中失血量;(7)对于瓣膜置换术后患者的维持剂量计算,换瓣数也应纳入考虑因素中。结论:在新的华法林个体化剂量预测模型的建立中,通过纳入以上影响因素,可能对提高剂量个体差异解释程度有帮助。
OBJECTIVE Although many individualized dose prediction algorithms of warfarin have been developed recently, there still exits some individual variation to be explained, due to the incompletion of the influence factors selected. So it is necessary to sort the factors further and screen the ones that are reliable. METHODS This research analyzed the influence factors of warfarin dose such as the gene polymorphism, concomitant medications, concomitant diseases, INR values and surgery, and their study basis. RESULTS The factors suggested to be included were listed as following：（1）CYP4F2. （2）For the drugs that were widely used or their influences have been validated by other algorithms, it was better to bring them into the dose model one by one, and for the drugs that were not widely used or their influences were indefinite, the total numbers of the them could be used to establish the algorithm. （3）Hepatic function, renal function and heart function; fever state and the level of leuko cytes. （4）Deep vein and pulmonary embolism. Tobacco/alcohol use. （5）Daily Vitamin K intake. （6）While determining the initial dose or single daily dose, the INR value in the initial days and the blood loss during operation should be taken into account. （7）The numbers of the replaced heart valves should also be considered in calculating the steady dose of warfarin for the patients after heart valve replacement. CONCLUSION In the development of new warfarin dose prediction model, more individual variation may be explained by including the above factors.
出处
《中国医院药学杂志》
CAS
CSCD
北大核心
2014年第16期1408-1414,共7页
Chinese Journal of Hospital Pharmacy
关键词
华法林
个体化
纳入因素
warfarin
individualized
included factors
