口服华法林患者综合监测临床研究

Investigation on integrated monitoring of oral warfarin patients

目的探讨冠状动脉造影及支架植入术后口服华法林患者血浆凝血酶原前体蛋白(PIVKA-Ⅱ)、凝血酶原时间(PT)、国际标准化比率(INR)、蛋白质Z(PZ)、细胞色素P4502C9基因CYP2C9*3的改变、临床意义及心理干预的疗效。方法 158例冠状动脉造影及支架植入术后口服华法林患者为研究组,25名门诊体检人员为对照组,分别进行血浆PZ、PIVKA-Ⅱ、PT、INR、CYP2C9*3测定。比较上述指标与临床的关系及各指标间的相关性,并对上述人员采用90项症状自评量表(SCL-90)进行心理评定。结果研究组首次服用华法林后4h,血浆PIVKA-Ⅱ浓度显著增高(P<0.05);首次服用华法林后24h,PT、INR显著增高(P<0.05);首次服用华法林后16hPZ显著增高(P<0.05)。研究组PIVKA-Ⅱ、PT、INR随时间增加而增高,而PZ随时间增加显著减低。CYP2C9*3的检出率为21.9%。另外95%的患者存在不同程度的心理问题(P<0.01),主要表现为焦虑、抑郁及其他症状。PIVKA-Ⅱ与INR正相关(P<0.05)。结论上述指标能较客观地反映冠状动脉造影及支架植入术后口服华法林患者的病理变化过程。动态观察对病情判断、指导治疗和预后有一定临床意义。同时还需要对患者进行心理健康指导。

Objective To investigate the changes of prothrombin precursor protein （PIVKA- Ⅱ）, prothrombin time （PT）, international normalized rate （INR）, protein Z （PZ） and P4502C9 gene CYP2C9＊3 in oral warfarin patients after the coronary artery angiography and stent implantation. Methods One hundred and fifty eight oral warfarin patients with coronary artery angiography and stent implantation and twenty-five outpatients were divided into experimental group and control group respectively, and the PIVKA-Ⅱ , PT, INR, PZ and CYP2C9＊3 in these patients were detected. The relationship between these indexes and clinical condition were analyzed, and tile psychological evaluation fin＂ these patients were made with 90 symptom checklist （SCL-90）. Results At 4 h, 16 h and 24 h after first warfarin administration, the concentration of PIVKA-Ⅱ, PZ, and P＇F, INR elevated significantly respectively （P〈0.05）. The contents of PIVKA- Ⅱ, PT, INR elevated gradually with the treating time, and the contents of PZ decreased with treating time significantly. The detection rate of CYP2C9＊3 was 21.9%. In addition, 95% patients had varied degree of psycho-problems （P〈0.01）, and manifest mostly depression and anxiety, fear, and other symptoms. The content of PIVKA-Ⅱ was positive correlation with INR （P〈0.05）. Conclusion These indexes can objectively reflect the pathological changes of oral warfarin patients after the coronary artery angiography and stent implantation. It is significant to dynamically observe fi^r judgment, treatment and prognosis of clinical conditio. In addition, the guidance on mental health for patients was also necessary.