【摘要】：[目的]研究華法林藥物基因組檢測在心臟瓣膜置換術后抗凝治療中的指導作用。[方法]按照標準選取昆明醫(yī)科大學第二附屬醫(yī)院心臟血管外科2015年7月至2016年12月首次行心臟瓣膜手術患者62例,并將其分為試驗組(行華法林藥物基因組檢測,并根據(jù)檢測報告中的建議預計劑量給予初始劑量)和對照組(未行華法林藥物基因組檢測,均給予3mg/d的華法林劑量),所有患者術后拔除氣管插管24小時內均給予口服華法林鈉抗凝治療,并依據(jù)國際標準化比值(INR)監(jiān)測結果對華法林進行調整,以INR值達到目標范圍,且華法林劑量穩(wěn)定為準。比較試驗組和對照組在華法林抗凝治療3、5、7d及出院達標率等方面的差異、華法林達標時間、穩(wěn)定劑量、試驗組中華法林預測劑量與穩(wěn)定劑量間的差異。[結果]試驗組患者CYP2C9*2基因以CC為主(100%),CYP2C9*3基因以AA型為主(97.22%),AC (2.78%) ; VKORC1 基因以 M 為主(88.9%),GG (0%),GA (1.11%);試驗組華法林穩(wěn)定劑量與預測劑量之間具有相關性(r=0.952,P0. 001);試驗組華法林在用藥3d,5d,7d及出院前抗凝指標達標率均有統(tǒng)計學意義(P0. 05);試驗組與對照組在華法林穩(wěn)定劑量及兩組患者住院期間出現(xiàn)不良反應的發(fā)生率均無統(tǒng)計學意義(P0. 05)。[結論]華法林基因組檢測在臨床中指導華法林抗凝治療,具有參考價值,可減少臨床醫(yī)師在華法林抗凝治療中的盲目性,尤其是在初始劑量的確定上,但也存在局限性,有待進一步更大規(guī)模、更完善、更深入、更符合中國人群的臨床研究。
[Abstract]:Objective: to study the guiding role of warfarin in anticoagulant therapy after valvular replacement. [methods] Sixty-two patients undergoing cardiac valvular surgery in the second affiliated Hospital of Kunming Medical University from July 2015 to December 2016 were selected and divided into two groups. The initial dose of warfarin and the control group (warfarin dose of 3mg/d were given without warfarin drug genome test), and the initial dose was given according to the recommended dose of warfarin in the test report. All patients were given oral warfarin sodium anticoagulant therapy within 24 hours after tracheal intubation, and warfarin was adjusted according to the results of international standardized ratio (INR) monitoring. The INR value reached the target range, and the warfarin dose was stable. The differences of warfarin anticoagulant therapy and discharge rate were compared between the test group and the control group. The time of warfarin reaching the standard and the stable dose were compared. The difference between the predicted dose and the stable dose of warfarin in the test group was compared. [results] in the test group, CC was the main gene of CYP2C9*2 (100%), AA was the predominant gene of CYP2C9*3 (97.22%), AC (2.78%), VKORC1 gene was M (88.9%), GG (0%), GA (1.11%). There was a correlation between the amount of warfarin stabilizer and the predicted dose in the test group (r = 0.952, P 0. In the test group, warfarin had significant difference in 3 days, 5 days, 7 days and before discharge (P 0. 01), and the anticoagulant index reached the standard rate before discharge (P 0. 01). There was no significant difference in the dosage of warfarin stabilizer and the incidence of adverse reactions during hospitalization between the two groups (P0. ) [conclusion] warfarin genome detection has reference value in guiding warfarin anticoagulant therapy in clinic, and can reduce the blindness of clinicians in warfarin anticoagulant therapy, especially in the determination of initial dosage, but it also has some limitations. Need to be further larger, more perfect, more in-depth, more in line with the Chinese population of clinical research.
【學位授予單位】：昆明醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R654.2

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