CAJ | 학술논문

目的探讨依据维生素K环氧化物还原酶复合体亚单位1(VKORC1)和细胞色素P450 2C9 (CYP2C9)基因多态性指导老年患者使用华法林抗凝的效应和安全性. 方法收集2011年2月至2012年8月急诊科和呼吸科有华法林抗凝适应证并初次抗凝的老年患者41例,其中依据基因多态性指导华法林用药20例(观察组),依据临床指标和相关指南给药21例(对照组),比较两组患者抗凝治疗不同时间段国际标准化比值(INR)达标率、INR达稳定目标值(2.0～3.0)的时间差异及随访半年内患者出血并发症的发生率. 结果观察组和对照组INR达标率第3天0.0％和0.0％；第4天42.1％(8/19)和10.0％(2/20),P＜0.05；第5天52.6％(10/19)和25.0％(5/20),P＞0.05；第7天68.4％(13/19)和35.0％(7/20),P＜0.05.观察组INR达稳定目标值的时间较对照组缩短[(9.5±2.4)d比(12.3±4.8)d,P＜0.05],观察组出血并发症3例,对照组5例,两组间差异无统计学意义(P＞0.05). 结论依据基因多态性指导老年患者使用华法林,能缩短华法林抗凝INR首次达标和达到稳定目标值的时间,但仍要高度警惕出血并发症的风险.
목적 탐토의거유생소K배양화물환원매복합체아단위1(VKORC1)화세포색소P450 2C9 (CYP2C9)기인다태성지도노년환자사용화법림항응적효응화안전성. 방법 수집2011년2월지2012년8월급진과화호흡과유화법림항응괄응증병초차항응적노년환자41례,기중의거기인다태성지도화법림용약20례(관찰조),의거림상지표화상관지남급약21례(대조조),비교량조환자항응치료불동시간단국제표준화비치(INR)체표솔、INR체은정목표치(2.0～3.0)적시간차이급수방반년내환자출혈병발증적발생솔. 결과 관찰조화대조조INR체표솔제3천0.0％화0.0％；제4천42.1％(8/19)화10.0％(2/20),P＜0.05；제5천52.6％(10/19)화25.0％(5/20),P＞0.05；제7천68.4％(13/19)화35.0％(7/20),P＜0.05.관찰조INR체은정목표치적시간교대조조축단[(9.5±2.4)d비(12.3±4.8)d,P＜0.05],관찰조출혈병발증3례,대조조5례,량조간차이무통계학의의(P＞0.05). 결론 의거기인다태성지도노년환자사용화법림,능축단화법림항응INR수차체표화체도은정목표치적시간,단잉요고도경척출혈병발증적풍험.
Objective To investigate the efficacy and safety of warfarin anticoagulation in Chinese elderly patients based on vitamin K epoxide reductase complex 1 (VKORC1) and cytochrome P450 2C9 (CYP2C9) genetic polymorphisms.Methods Clinical data of 41 elderly patients with initial anticoagulation therapy in our emergency department and respiratory department were collected.Patients were divided into observation group (n=20,patients treated with warfarin based on genetic polymorphisms) and control group (n =21,patients treated based on clinical experience).The international normalized ratio (INR),the time of INR stabilized within target range (2.0-3.0) and the incidence of bleeding episodes in 6-month follow up were compared between groups.Results INR within target range at day 3,4,5 and 7 were 0.0％,42.1％,52.6％,68.4％ in observation group and 0.0％,10.0％,25.0％,35.0％ in control group,respectively.There were significant differences in INR within target range at day 4,7 between the two groups (both P＜0.05),while no significant difference was found in INR within target range at day 5 (P＞0.05).The time of INR stabilized within target range was shorter in observation group than in control group [(9.5±2.4) d vs.(12.3± 4.8) d,P＜0.05].Bleeding complication occurred in 3 patients in observation group and 5 patients in control group,and there was no significant difference between the two groups.Conclusions Warfarin therapy based on VKORC1 and CYP2C9 gene polymorphisms may shorten the time of first INR reaching the target value and INR within target range in elderly patients.However,the risk of bleeding complications should be alerted.