摘要
目的探究细胞色素P450酶2C9(CYP2C9)和维生素K环氧化物还原酶复合体亚单位1(VKORC1)基因检测对急性肺血栓栓塞症患者个体化华法林抗凝治疗的指导价值。方法前瞻性选取2018年1月至2020年10月简阳市人民医院收治的68例急性肺血栓栓塞症患者作为研究对象,对患者CYP2C9和VKORC1基因型予以检测,按照随机数字表法分为观察组(给予基因指导)与对照组(常规疗法)2组,每组各34例。比较2组患者国际标准化比值(INR)首次达目标范围时间、达稳定剂量时间、住院时间,随访不同时间点INR值及不良反应发生率。结果观察组INR首次达目标范围时间、达稳定剂量时间及住院时间分别为(8.21±1.31)、(14.02±2.32)、(13.31±2.46)d,均明显短于对照组[(10.39±2.16)、(19.31±2.21)、(15.89±2.27)d],差异均有统计学意义(P<0.05)。观察组患者第4、8、12、16、20、24、28天的INR值与对照组比较,差异有统计学意义(P<0.05)。观察组患者不良反应发生率(5.88%)明显低于对照组(29.41%),差异有统计学意义(P<0.05)。结论CYP2C9和VKORC1基因检测能够为急性肺血栓栓塞症个体化华法林抗凝治疗提供有效的指导,帮助更快达到华法林稳定剂量及INR目标范围,减少不良反应的发生,应予以重视。
Objective To explore the guiding value of cytochrome P450ase 2C9(CYP2C9)and vitamin K oxide reductase complex subunit 1(VKORC1)gene detection for individualized warfarin anticoagulant therapy in patients with acute pulmonary thromboembolism.Methods Sixty-eight patients with acute pulmonary thromboembolism admitted to Jianyang People's Hospital from January 2018 to October 2020 were prospectively selected as subjects,and CYP2C9 and VKORC1 genotypes were detected.According to random number table method,the patients were divided into observation group(given genetic guidance)and control group(conventional therapy),with 34 cases in each group.The international standardized ratio(INR)time to reach the target range for the first time,the time to reach the stable dose,the length of hospital stay,the INR value and the incidence of adverse reactions were compared between the two groups.Results The first time to reach the target range,the time to reach the stable dose and the length of hospital stay in the observation group were were(8.21±1.31),(14.02±2.32),and(13.31±2.46)d,which were significantly shorter than those in the control group[(10.39±2.16),(19.31±2.21),(15.89±2.27)d],the differences were statistically significant(P<0.05).The INR values of observation group at day 4,8,12,16,20,24 and 28 were compared with those of control group,and the difference was statistically significant(P<0.05);The incidence of ADR in observation group(5.88%)was significantly lower than that in control group(29.41%),and the difference was statistically significant(P<0.05).Conclusion CYP2C9 and VKORC1 gene testing can provide effective guidance for individualized warfarin anticoagulant therapy in acute pulmonary thromboembolism,help achieve warfarin stable dose and INR target range faster,and reduce the occurrence of adverse reactions,which should be paid attention to.
作者
刘文凤
贾坤林
徐翠容
邓海波
陈杰
LIU Wen-feng;JIA Kun-lin;XU Cui-rong(Department of Respiratory Medicine,Jianyang People's Hospital,Jianyang Sichuan 641400,China.)
出处
《临床和实验医学杂志》
2021年第15期1618-1620,共3页
Journal of Clinical and Experimental Medicine
基金
四川省卫生厅科研课题(编号:120286)。
