心房颤动射频消融术后患者基因检测指导下华法林个体化用药的有效性及安全性

Efficacy and safety of individual warfarin therapy with the guidance of genetic testing after radiofrequency ablation for atrial fibrillation

目的探讨心房颤动射频消融术后患者基因检测指导下的华法林个体化用药的有效性及安全性。方法选取2012—2015年在新疆维吾尔自治区人民医院接受心房颤动射频消融术治疗的414例患者为研究对象,根据患者意愿将其分为2组,分别接受基因检测指导下华法林个体化用药(基因检测组,198例)和常规负荷剂量用药(非基因检测组,216例)。术后随访12个月,通过心血管事件(包括心源性死亡、卒中和急性冠状动脉综合征)和出血的发生情况评价华法林基因检测在心房颤动射频消融术后抗凝治疗中的作用。结果剔除不符合纳入标准及失访者,最终351例患者完成试验,其中基因检测组170例,非基因检测组181例。Kaplan-Meier生存分析结果显示,基因检测组的心血管事件发生率明显低于非基因检测组[2.9%(5/170)比5.5%(10/181),风险比=0.407,95%置信区间:0.236～0.703,P=0.001],主要体现在卒中方面[1.8%(3/170)比3.9%(7/181),风险比=0.454,P=0.046],而心源性死亡和急性冠状动脉综合征发生率2组间差异无统计学意义(P>0.05)。基因检测组的出血发生率明显低于非基因检测组[1.8%(3/170)比5.5%(10/181),风险比=0.413,95%置信区间:0.198-0.861,P=0.018]。结论基因检测指导下华法林个体化用药可减少心房颤动射频消融术后患者发生不良心血管事件,同时可降低出血的风险,其临床效果优于非基因指导的常规负荷剂量用药。

Objective To investigate the efficacy and safety of individual warfarin therapy with the guidance of genetic testing after radiofrequency ablation for atrial fibrillation. Methods A total of 414 atrial fibrillation patients who had radiofrequency ablation from 2012 to 2015 in People＇s Hospital of Xinjiang Uygur Autonomous Region were enrolled, and they were allocated to have individual warfarin therapy with the guidance of genetic testing（ genetic testing group, 198 cases） and routine loading dose of warfarin（ non-genetic testing group,216 cases）. Occurrences of adverse cardiovascular events（ cardiac death, stroke and acute coronary syndrome） and bleeding were recorded through 12 months of follow-up. Results Finally 351 patients were analyzed, including 170 cases in genetic testing group and 181 cases in non-genetic testing group. Kaplan-Meier survival analysis showed that incidence of cardiovascular events in genetic testing group was significantly lower than that in non-genetic testing group[2.9% （5/170） vs 5.5% （10/181）, hazard ratio = 0. 407, 95% confidence interval： 0. 236-0. 703, P = 0. 001 ] ; incidence of stroke in genetic testing group was significantly lower than that in non-genetic testing group [ 1.8% （3/170） vs 3.9% （7/181）, hazard ratio = 0. 454, P = 0. 046.] ; incidences of cardiac death and acute coronary syndrome showed no significant differences between groups（P 〉0. 05 ）. Bleeding rate in genetic testing group was significantly lower than that in non-genetic testing group [ 1.8% （3/170） vs 5.5%（10/181）, hazard ratio =0.413, confidence interval： 0. 198-0.861, P =0.018]. Conclusion Individual warfarin medication with the guidance of genetic testing can reduce adverse cardiovascular events and bleeding risk in atrial fibrillation patients after radiofrequency ablation.