基于ROC曲线预测华法林治疗患者抗凝强度的研究

Critical value of warfarin initial INR for predicting stable INR using receiver operating characteristic curve

探讨华法林治疗患者起始国际标准化比值(INR)预测抗凝强度未达标的能力。纳入108例华法林治疗患者,予华法林2.5 mg/d治疗2 d后晨起检测起始INR值,并于服药7 d后重复检测稳态INR值,INR<2定义为抗凝强度未达标。利用受试者工作曲线(ROC curve)检验起始INR值对华法林抗凝治疗未达标的预测效力。利用起始INR值预测华法林治疗抗凝强度未达标的ROC曲线下面积(AUC)为0.872(95%CI=0.772~0.973,P<0.001)。当最佳临界值(CP)为1.145时,预测抗凝强度未达标的敏感性为82.65%,特异性为80%,阳性预测值为97.59%,阴性预测值为32%。通过起始INR值预测华法林抗凝未达标的效力良好,多数华法林治疗患者在使用2.5 mg/d后,如果起始INR值小于1.145,应考虑积极调整华法林剂量。

To evaluate critical value of warfarin initial international normalized radio(INR)for predicting stable INR using receiver operating characteristic curve.A total of 108 patients with warfarin treatment of 2.5 mg/d were enrolled as the subjects,who detected initial INR after two days and detected stable INR after 7 days,INR<2 defined as anticoagulation intensity dissatisfaction.To verify initial INR predicting stable INR using receiver operating characteristic curve.The area under the ROC curve for initial INR to predicting stable INR was 0.872(95%CI:0.772~0.973,P<0.001),when cut point was 1.145,the sensitivity was 82.65%,the specificity was 80%.Positive predictive value was 97.59%,negative predictive value was 32%.Through initial INR value prediction of warfarin anticoagulation effect was good,the majority of patients with warfarin therapy after using of 2.5 mg/d,if the initial INR value is less than 1.145,actively adjust the warfarin dose should be taken into account.