机械瓣膜置换术后中国人群华法林抗凝治疗的研究进展

Advances in warfarin′s anticoagulation therapy in Chinese population after mechanical valve replacement

华法林是机械瓣膜置换术后患者不可替代的口服抗凝药物,近年来,基于遗传药理学构建的华法林稳定剂量预测模型一定程度上提高了华法林抗凝治疗的有效性和安全性。遗传因素是影响华法林稳定剂量的主要因素,VKORC1、CYP2C9等基因通过作用于华法林药理或代谢途径影响华法林抗凝效果。此外,年龄、体表面积、合并用药等非遗传因素也对华法林稳定剂量有影响。既往发表的华法林剂量预测模型纳入人群以高加索人为主,模型构建方法多为传统多元线性回归。而国内研究根据中国汉族机械瓣膜置换术后人群,采用机器学习方法构建华法林剂量预测模型并取得了更好的预测效能。

Warfarin is an irreplaceable oral anticoagulant for patients with mechanical heart valves,the stable pharmacogenetic-based warfarin dose prediction algorithms have improved the effectiveness and safety of warfarin anticoagulation therapy.Genetic factors are the main factors affecting the stable dose of warfarin.Single nucleotide polymorphisms such as VKORC1 and CYP2C9 affect the anticoagulation effect of warfarin through pharmacodynamic or pharmacokinetic pathways.Age,body surface area,combined use of drugs,and other nongenetic factors also affect the stable dose of warfarin.Previously published algorithms for warfarin dose prediction included mainly the white race,and most algorithms were constructed using traditional multiple linear regression.However,domestic studies have used machine learning methods to construct warfarin dose prediction algorithms based on the Chinese Han post-mechanical valve replacement population and have achieved better prediction efficiency.This article reviews the advances of warfarin anticoagulation influencing factors and the clinical application of stable dose prediction algorithms.