CYP2C9和VKORC1基因检测指导心脏瓣膜置换术后华法林用药的研究

Clinical study of CYP2C9 and VKORC1 gene detection in guiding of warfarin medication after cardiac valve replacement

目的分析不同CYP2C9和VKORC1基因分型的心脏瓣膜置换术后患者华法林达标剂量、达标时间,探讨基因检测对心脏瓣膜置换术后患者华法林用药的指导意义。方法随机选取156例心脏瓣膜置换术后患者作为研究对象,按照CYP2C9基因和VKORC1基因的检测结果分别分为CYP2C9*3 AA组(142例)、CYP2C9*3 AC组(14例)和VKORC1 GA/GG组(25例)、VKORC1 AA组(131例)。比较各组患者的年龄、体质量、身高、手术方式、干扰药物使用情况、实际达标剂量、达标时间并进行统计学分析。结果CYP2C9*3 AC组华法林达标剂量低于CYP2C9*3 AA组,差异有统计学意义(P<0.05);2组达标时间比较,差异无统计学意义(P>0.05)。VKORC1 GA/GG组华法林达标剂量高于VKORC1 AA组,差异有统计学意义(P<0.001);2组达标时间比较,差异无统计学意义(P>0.05)。结论CYP2C9和VKORC1基因检测结果对心脏瓣膜置换术后患者华法林用药具有指导意义,有利于指导华法林初始剂量的选择,但对达标时间的影响不大。

Objective To analyze the standard dose and time of warfarin in patients with different CYP2 C9 and VKORC1 genotypes after heart valve surgery,so as to analyze the significance of gene detection in guiding warfarin medication in patients after heart valve surgery.Methods A total of 156 patients who underwent heart valve surgery were randomly selected as study objects,and were divided into four groups according to the test results of CYP2 C9 and VKORC1 gene:CYP2 C9*3 AA group(142 cases),CYP2 C9*3 AC group(14 cases),VKORC1 GA/GG group(25 cases)and VKORC1 AA group(131 cases).The age,weight,height,operation method,usage of interference drug,actual standard dose and standard time of different groups were compared.Results The dose of warfarin reaching standard in the CYP2 C9*3 AC group was significantly lower than that in the CYP2 C9*3 AA group(P<0.05),but there was no significant difference in time of reaching standard between the two groups(P>0.05);the standardized dose of warfarin in the VKORC1 GA/GG group was significantly higher than that in the VKORC1 AA group(P<0.001),but there was no significant difference in time of reaching standard between the two groups(P>0.05).Conclusion Gene detection of CYP2 C9 and VKORC1 is of significance in guiding the use of warfarin in patients after heart valve surgery,which is helpful to guide the selection of initial warfarin dose,but has little influence on the time of reaching the standard.