基因检测对于房颤导管消融术后华法林初始抗凝治疗的影响

Significance of the genetic theory on the initial warfarin anticoagulantion of patients with atrial fibrillation after catheter ablation

目的探讨CYP2C9*3和VKORC1-1639G/A基因检测对于房颤消融术后患者华法林初始抗凝治疗的影响。方法60例房颤射频消融术后接受华法林抗凝治疗的患者纳入对照组和试验组。试验组依据基因检测结果及国际华法林药物基因组模型确定华法林初始剂量,对照组依据体质量数确定初始剂量。服药后第4d和第7d查INR,比较两组INR达标率和不良反应发生的差异。结果试验组第4d INR达标率53.33%及第7d INR达标率76.67%均明显高于对照组(第4d INR达标率26.67%,第7d INR达标率50%),而不良反应事件发生明显低于对照组。结论 CYP2C9*3和VKORC1-1639G/A基因多态性的检测对于房颤消融术后患者华法林初始抗凝治疗剂量有指导意义。

Objective To investigate the significance of CYP2C9＊3 and VKORCl-1639G/A gene on the initial warfarin anticoagulantion of patients with atrial fibrillation after catheter ablation. Methods 60 patients with atrial fibrillation treated warfarin after catheter ablation were enrolled in the study,and devided into control group and test group. The initial doses of wafarin was determined according to the body weight in control group. In test group,the initial dose of warfarin was determined according to the genotype,international pharmaeogenetics consortium （IWPC） algorithma. The INR was detected in the fourth day and in the seventh day. The INR target rate of warfarin and the adverse reaction was compared in two groups. Results The INR target rate of warfarin in the fourth day （53.33%） and in the senenth day （76.67%） in test group were significantly higher than those in control group （26.67%,50%）,the adverse reaction in test group was significantly less than that in control group. Conclusion The detection of the CYP2C9＊3 and VKORCl-1639G/A genetic polymorphisms has some guidance significance to the determination of the initial dose of wafarin anticoagulation in patients with atrial fibrillation after catheter abalation.