心脏瓣膜置换术后国际标准化比值与华法林对映体血浆浓度及给药剂量的相关性研究

Study on the Correlation between International Normalized Ratio with Plasma Concentration of Warfarin Enantiomer and Dose Density after Cardiac Valve Replacement

目的：探讨心脏瓣膜置换术后国际标准化比值（INR）与华法林对映体血浆浓度及给药剂量的相关性。方法：监测176例心脏机械瓣膜置换术后接受华法林抗凝治疗的患者各时间点给药剂量、R-华法林和S-华法林血浆浓度及INR,观察INR与华法林对映体血浆浓度及单位体质量给药剂量的相关性。结果：所有患者给药剂量在24～288 h时均显著高于0 h时,差异均有统计学意义（P〈0.001）;96 h后患者给药剂量在一定范围内上下波动,较96 h时差异均无统计学意义（P〉0.05）。R-华法林、S-华法林平均血浆浓度变化趋势一致,108 h后对映体血浆浓度在一定范围内上下波动,差异均无统计学意义（P〉0.05）。INR在12 h时较0 h时比较差异无统计学意义（P〉0.05）,在36 h时显著上升,之后一直上升,至108 h后在一定范围内上下波动,较108 h时差异均无统计学意义（P〉0.05）。INR与华法林单位体质量给药剂量60 h时相关系数〉36 h时〉12 h时,且具有相关性（P〈0.001）;华法林血浆浓度与给药剂量在12、36、60 h时均有一定相关性（P〈0.001）。结论：华法林对映体血浆浓度与单位体质量给药剂量的相关性强于INR与单位体质量剂量的相关性,在同其他凝血指标相结合时,可能有助于华法林的剂量管理。

OBJECTIVE： To discuss the correlation between Intemtion Normalized Ratio （INR） with concentration of warfarin enantiomer and dose density after cardiac valve replacement. METHODS： The plasma concentration of R-warfarin or S-warfarin, dose of unit weight and INR of 176 patients with anticoagulation after cardiac valve replacement in each time point were moni- tored, and the correlation of INR and warfarin plasma concentration or dose was observed. RESULTS： Doses of all patients in 24-288 h were significantly higher than 0 h, the differences were statistically significant（P〈0.001）, the dose was fluctuated within a certain range after 96 h, and compared with 96 h, there were no significant differences（P〉0.05）. Average plasma concentration of R-warfarin or S-warfarin had consistent trend, plasma concentration of enantiomers was fluctuated within a certain range after 108 h, there were no significant differences（P〉0.05）. Compared with 0 h, there was no significant difference when INR was 12 h （P〉0.05）, it increased significantly in 36 h and had been increasing, then fluctuated within a certain range after 108 h, compared with 108 h, there were no significant differences （P〉0.05）. The correlation coefficient between INR and unit weight dose of warfa- rin in 60 h〉36 h〉 12 h, it showed correlation（P〈0.001）. There was certain correlation between plasma concentration of warfarin and dose density in 12, 36 and 60 h. CONCLUSIONS： The correlation between plasma concentration of warfarin and unit weight dose is stronger than the correlation between INR and unit weight dose. When combined with other coagulation, it may help to man- age warfarin dose.