心脏瓣膜置换术后影响华法林抗凝疗效的人口学因素分析

Effect of demographic factors on warfarin dosing in patients after cardiac valve replacement

目的:探讨影响心脏瓣膜置换术后患者华法林维持剂量的人口学因素,以指导术后的抗凝治疗。方法:收集852例心脏瓣膜置换术后使用华法林抗凝治疗的患者资料,分别将华法林维持剂量与性别、年龄、体表面积、吸烟、饮酒等因素进行相关性分析,采用逐步回归方法分析这些人口学因素对华法林维持剂量的影响。结果:(1)女性患者华法林的维持剂量和PT-INR(凝血酶原国际标准化比值)都要比男性患者小。(2)华法林维持剂量与年龄呈负相关(r=-0.250,P<0.001),与体表面积呈正相关(r=0.337,P<0.001)。(3)年龄和体表面积可以解释华法林维持剂量个体差异的17.9%。结论:本研究证实一些人口学因素例如年龄和体表面积可以解释华法林维持剂量的部分个体差异,接下来还需进一步地探讨其他因素,例如遗传因素对华法林剂量的影响。

Objective To study the effect of the demographic factors on warfarin maintenance dose in patients after cardiac valve replacement. Methods Demographic and clinical data of 852 patients received warfarin treatment after cardiac valve replacement were collected. The association analysis of warfarin maintenance dose with the sex, age, body surface area, smoking status and drinking status were performed and Step-wise regression analysis were used to analyze the contribution of demographic factors to warfarin maintenance dose. Results （ 1 ）The mean maintenance dose of warfarin and the resulted PT-INR （prothrombin time-international normalized ratio） in female patients were less than those in male patients. （2）The maintenance dose of warfarin was negatively correlated with age （r = -0.250, P 〈 0.001） and positively correlated with body surface area （r = 0.337, P 〈 0.001 ）. （3）Age and body surface area index contributed to 17.9% interindividual variability in warfarin maintenance dose. Conclusions The study confirmed that the demographic factors such as age and body surface area index could explain part of variability of warfarin maintenance dose. Further studies are needed to investigate the effects of other factors, such as genetic.