摘要
目的了解不同CYP2C9及GGCX基因型对人工瓣膜置换术后抗凝效果的影响。方法选取2013年1月-2016年12月在该院心脏外科接受心脏瓣膜置换术的患者,采集服药后空腹12 h的外周静脉血3 ml进行CYP2C9和GGCX基因型检测,收集患者相关临床资料,采用SPSS 21.0软件进行数据分析。结果选取80例患者,CYP2C9基因型有2种,包括73例CYP2C9*1*1和7例CYP2C9*1*3患者;42例GGCX*A*G型和38例GGCX*G*G型患者。两种基因型患者在性别、年龄、体质指数(BMI)、凝血酶原时间(PT)、国家标准化比值(INR)值及达到稳定抗凝效果后的华法林血药浓度差异无统计学意义(P<0.05),但CYP2C9*1*1型患者INR首次达标时间>CYP2C9*1*3型患者(P=0.013),CYP2C9*1*1型患者华法林日均稳定维持剂量>CYP2C9*1*3型患者(P=0.011),GGCX*A*G型患者华法林日均稳定维持剂量>GGCX*G*G型患者(P=0.000),同时为CYP2C9*1*1型和GGCX*A*G型的患者华法林日均稳定维持剂量>其他3组(P=0.024)。CYP2C9基因型(P=0.001)和GGCX基因型是影响患者术后第6天是否能达到治疗窗的影响因素(P=0.032)。结论根据CYP2C9基因型和GGCX基因型确定个人使用剂量,可提高患者抗凝治疗效果。
Objective To investigate the impact of different genotypes of CYP2C9and GGCX on anticoagulative effect after prosthetic valve replacement.Methods Patients who received prosthetic valve replacement in our hospital between2013and2016were enrolled in the research,CYP2C9and GGCX genotypes were tested with3ml peripheral venous blood sample which was collected after taking medicire and fasting for12h and clinical data were collected for all the patients enrolled.SPSS21.0software was used for statistical analysis.Results Eighty patients were enrolled in this research,and two types of CYP2C9gene were found,including CYP2C9*1*1in73patients and CYP2C9*1*3in7patients.For GGCX gene,there were42GGCX*A*G patients and38GGCX*G*G patients.There was no significant difference between the two groups in the gender,age,BMI,PT,INR value,or the maintenance blood concentration of Warfarin.Honever it was longer for CYP2C9*1*1patients to reach the first effective INR value than that of the CYP2C9*1*3patients(P=0.013).The daily maintenance dosage of Warfarin for CYP2C9*1*1patients was higher than that of CYP2C9*1*3patients(P=0.011),and GGCX*A*G patients'daily maintenance dosage of Warfarin was higher than GGCX*G*G patients'(P=0.000).Those patients with both CYP2C9*1*1and GGCX*A*G needed higher daily maintenance dosage of Warfarin than others(P=0.024).CYP2C9gene was a significant influencing factor associated with INR within the therapeutic window on the6th day after operation.Conclusions Prediction of individual Warfarin dosage based on patient's CYP2C9gene and GGCX gene can improve the anticoagulative effect.
作者
陈洪晔
于波
谭启明
李勇
秦良光
杨研
Hong-ye Chen;Bo Yu;Qi-ming Tan;Yong Li;Liang-guang Qin;Yan Yang(Department of Cardiovascular Surgery, Lianyungang First People's Hospital, Lianyungang,Jiangsu 222000, China;Fuwai Hospital, Chinese Academy of Medical Sciences,Beijing 100037, China)
出处
《中国现代医学杂志》
CAS
北大核心
2017年第18期62-65,共4页
China Journal of Modern Medicine
