非瓣膜性房颤华法林用量与CYP4502C9基因多态性的相关性

The correlation between CYP4502C9 gene polymorphism and the doses of warfarin in patients with non-valvular atrial fibrillation

目的:深入研究CYP4502C9基因多态性与中原地区非瓣膜性房颤患者应用华法林抗凝达标时的维持量及出血等并发症的相关性。方法:选取2012年9月至2013年6月于郑州大学人民医院心血管内科采用华法林抗凝达标的66例非瓣膜性房颤患者作为研究对象,根据CYP4502C9基因多态性分为突变组和非突变组。记录一般情况、华法林维持量及INR值,随访服药期间发生的临床事件。结果:该样本CYP4502C9*3与CYP4502C9*2基因型分布符合Hardy-Weinberg遗传平衡定律(P>0.05),具有群众代表性;CYP4502C9*3基因非突变组华法林稳定达标时的平均维持量高于突变组[(2.656±0.185)mg/d VS(1.948±0.354)mg/d](P<0.05);突变组华法林用药初始阶段出血事件发生率高于非突变组(P<0.05)。结论:基因水平指导下的个体化给药方案可以提高华法林在非瓣膜性房颤患者用药中的安全性、有效性。

Objective： To explore the correlation between warfarin dosage and the associated complications of patients with non-valvular atrial fibrillation and the gene polymorphism of cytochrome oxidase CYP4502C9 in central China. Methods： 66 patients with non-valvular atrial fibrillation, who reached steady state by long-term using warfarin in the department of vasculocardiology of People＇ s Hospital of Zhengzhou University from September 2012 to June 2013, were collected and divided into mutation group and non-mutation group according to the gene polymorphism analysis of CYP4502C9. General conditions, maintenance doses of warfarin, INR and the clinical events were recorded. Results ： Genotype distributions of CYP4502C9 ＊ 3 and CYP4502C9 ＊ 2 were consistent with the Hardy-Weinberg Genetic Balance Law （P 〉 0.05 ） ; The average maintenance dose of warfarin in patients of non-mutation group was higher than mutation group [ （2. 656 ± 0. 185） mg/d VS （ 1. 948 ± 0. 354） mg/d ] （P 〈 0.05 ）. The incidence of bleeding events in mutation group was higher than non-mutation group at the initial stage of using warfarin（P 〈 0. 05 ）. Conclusion ： The personalized medicine according to the genetic background in patients with non-valvular atrial fibrillation can improve the safety and effectiveness of warfarin.