發(fā)布時(shí)間：2019-01-23 19:31

【摘要】：[目的]研究華法林藥物基因組檢測(cè)在心臟瓣膜置換術(shù)后抗凝治療中的指導(dǎo)作用。[方法]按照標(biāo)準(zhǔn)選取昆明醫(yī)科大學(xué)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(shù)患者62例,并將其分為試驗(yàn)組(行華法林藥物基因組檢測(cè),并根據(jù)檢測(cè)報(bào)告中的建議預(yù)計(jì)劑量給予初始劑量)和對(duì)照組(未行華法林藥物基因組檢測(cè),均給予3mg/d的華法林劑量),所有患者術(shù)后拔除氣管插管24小時(shí)內(nèi)均給予口服華法林鈉抗凝治療,并依據(jù)國際標(biāo)準(zhǔn)化比值(INR)監(jiān)測(cè)結(jié)果對(duì)華法林進(jìn)行調(diào)整,以INR值達(dá)到目標(biāo)范圍,且華法林劑量穩(wěn)定為準(zhǔn)。比較試驗(yàn)組和對(duì)照組在華法林抗凝治療3、5、7d及出院達(dá)標(biāo)率等方面的差異、華法林達(dá)標(biāo)時(shí)間、穩(wěn)定劑量、試驗(yàn)組中華法林預(yù)測(cè)劑量與穩(wěn)定劑量間的差異。[結(jié)果]試驗(yàn)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(yàn)組華法林穩(wěn)定劑量與預(yù)測(cè)劑量之間具有相關(guān)性(r=0.952,P0. 001);試驗(yàn)組華法林在用藥3d,5d,7d及出院前抗凝指標(biāo)達(dá)標(biāo)率均有統(tǒng)計(jì)學(xué)意義(P0. 05);試驗(yàn)組與對(duì)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(yīng)的發(fā)生率均無統(tǒng)計(jì)學(xué)意義(P0. 05)。[結(jié)論]華法林基因組檢測(cè)在臨床中指導(dǎo)華法林抗凝治療,具有參考價(jià)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(jìn)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(xué)位授予單位】：昆明醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R654.2

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