【摘要】 目的:评价CYP2C9基因多态性对二尖瓣和主动脉瓣联合瓣膜置换术后华法林抗凝效果的影响。方法:选择2014年10月至2017年3月,在我院接受联合瓣膜置换术的患者65例,随机分为自我检测组32例和标准检测组33例,分别给予凝血检测仪和定期门诊复诊监测INR,同时对所有患者进行VKORC1和CYP2C9基因型检测,比较不同基因型和监测方法对华法林剂量和INR达标的影响。结果:非CYP2C9*2/3组INR检测次数低于CYP2C9*2/3组(P<0.05),而CYP2C9*2/3组TTR比例、华法林预计剂量及实际剂量均低于非CYP2C9*2/3组(P<0.05),两组轻微出血事件比例组间比较,差异无统计学意义(P>0.05);不同检测方法组TTR比例、超过TTR比例、低于TTR比例、INR测量次数、华法林预计剂量及实际剂量、轻微出血事件比例组间比较差异均无统计学意义(P>0.05)。结论:CYP2C9*2和/或*3基因型增加联合瓣膜置换术后3个月华法林抗凝效果的不确定性,但不会增加心血管事件的发生率,同时INR自我检测不能改善TTR达标比例。更多还原

【Abstract】 Objective: To evaluate CYP2C9 gene polymorphism on warfarin anticoagulation after mitral valve and aortic valve replacement. Methods: From October 2014 to March 2017,65 patients of combined valve replacement in our hospital were randomly divided into self-test group( n = 32) and standard test group( n = 33). Blood coagulation tester and regular outpatient INR monitoring were given. Patients underwent VKORC1 and CYP2C9 gene type detection. The effects of different genotypes and method for warfarin dose and INR reach rate were compared. Results: The INR detection times of non CYP2C9* 2/3 group were lower than CYP2C9* 2/3 group( P < 0. 05). TTR ratio,warfarin expected dose and actual dose of CYP2C9* 2/3 group were lower than non CYP2C9* 2/3 group( P < 0. 05). There was no significant difference between groups in minor bleeding events( P > 0. 05). Different detection method of group TTR ratio,above TTR ratio,below TTR ratio,warfarin predicted dose and actual dose,the proportion of minor bleeding events between the groups were not statistically significant( P > 0. 05). Conclusion: CYP2C9 * 2 and/or * 3 genotype increased uncertainty after valve replacement combined,but don’t the increased incidence of cardiovascular events. INR self-testing does not improve TTR ratio.更多还原