CYP2C9基因突变与心脏瓣膜置换术后华法林初始剂量的相关性研究

A Correlation Study between Warfarin Initial Dose and Genetic Mutation of Cytochrome CYP2C9 after Cardiac Valve Replacement

目的探讨心脏机械瓣膜置换术后服用华法林抗凝的初始剂量与细胞色素P450酶2C9（CYP2C9）基因突变的关系。方法选择我院2012年3—8月行心脏机械瓣膜置换手术的108例,根据是否有CYP2C9基因突变分为突变组8例和无突变组100例,比较两组华法林初始累积剂量及国际标准化比值（INR）的变化。结果两组华法林初始累积剂量比较差异无统计学意义（P〉0.05）。术后患者在服用华法林第1~5天,突变组INR值均较无突变组升高（P〈0.05）。结论 CYP2C9＊3杂合突变对华法林服药初期INR值影响很大,有较大的出血风险,建议在用药之前做基因检测。

Objective To study the correlation between Warfarin initial dose for anticoagulation therapy and the genetic mutation of cytochrome P450 2C9 （CYP2C9） in patients following mechanical heart of valve replacement. Meth- ods A total of 108 patients undergoing mechanical heart of valve replacement from March to August 2012 were recruited in this study, and were divided into mutation group （n = 8） and non- mutation group （n = 100）. The changes of Warfa- rin initial cumulative dose and international normalized ratio （INR） in the two groups were compared. Results There were no significant differences in Warfarin initial cumulative doses in the two groups （ P 〉 0.05 ）. INR values of postoper- ative patients taking Warfarin for 1-5 d in mutation group were increased more than those in non-mutation group （P 〈 0. 05 ）. Conclusion The CYP2C9 ＊ 3 mutation has great influence on the INR value at the beginning of Warfarin admin- istration, so gene test should be performed before using Warfarin anticoagulant therapy in order to prevent hemorrhage.