利伐沙班与基因检测指导的华法林治疗下肢深静脉血栓的研究

Clinical study on the treatment of deep venous thrombosis in lower extremity by Rivaroxaban and gene detection guide Warfarin

目的探讨利伐沙班与基因检测指导的华法林治疗下肢深静脉血栓形成患者的临床效果。方法选择160例下肢深静脉血栓患者,根据治疗方案分为利伐沙班组(n=80)和基因检测组(n=80)。利伐沙班组采用利伐沙班治疗,基因检测组根据cyp2c9及vkorc1基因检测结果给予华法林治疗,两组均治疗6个月,在治疗期间对患者进行1个月、3个月及6个月随访,对患者效果进行评估,比较两组临床疗效。结果利伐沙班组利伐沙班治疗后1个月、3个月、6个月患者依从性,均高于基因检测组(P <0. 05);利伐沙班组治疗后6个月复发率,低于基因检测组(P <0. 05);利伐沙班组治疗后6个月生理健康、心理状态、社会关系、周围环境、独立能力,均高于基因检测组(P <0. 05);利伐沙班组治疗后6个月颅内出血、胃肠道出血、肉眼血尿、皮肤及黏膜出血发生率,均低于基因检测组(P <0. 05)。结论利伐沙班用于下肢静脉血栓中抗凝效果更佳,能提高患者服药依从性及治疗后生活质量水平,且药物不会增加出血事件发生率。

Objective To investigate the clinical effect of Rivaroxaban and gene-guided warfarin in the treatment of deep vein thrombosis of the lower extremities.Methods A total of 160 patients with deep venous thrombosis of the lower extremities who were admitted to hospital for vascular surgery in the provincial hospital of Anhui medical university from February 2016 to February 2018 were selected and divided into a Rivaroxaban group (n=80) and a genetic testing group (n=80) according to the treatment plan.The Rivaroxaban group was treated with Rivaroxaban and the gene test group was given warfarin according to the results of cyp2c9 and vkorc1 gene detection (using polymerase chain reaction-restriction fragment length polymorphism).After 6 months of treatment,the patients were followed up for 1 month,3 months and 6 months during the treatment period to evaluate the effect of the patients and compare the clinical efficacy of the two groups.Results One month,three months and six months after treatment with Rivaroxaban patient′s complieance in the Rivaroxaban group were significantly higher than that in the genetic test group (P<0.05).The relapse rate was 6 months after the treatment with Rivaroxaban and lower than that in the genetic testing group (P< 0.05).6 months after the treatment of Rivaroxaban group,the physiological health,psychological state,social relations,surrounding environment and independent ability were all higher than those of the gene detection group (P<0.05).The incidence of intracranial hemorrhage,gastrointestinal bleeding,gross hematuria and skin and mucous membrane haemorrhage in the Rivaroxaban group were lower those that in the gene detection group at 6 months after treatment (P<0.05).Conclusion Rivaroxaban has better anticoagulant effect on venous thrombosis of the lower extremities and can improve the compliance of the patients and the quality of life after treatment without increasing the incidence of bleeding events.