【摘要】 目的 分析华法林与胺碘酮药物相互作用与肾功能的关系，探索华法林与胺碘酮药物相互作用异质性的来源。方法 回顾性收集华法林和胺碘酮合并用药的患者纳入试验组，收集仅使用华法林未合并使用胺碘酮的患者纳入对照组。根据肾功能水平进行分层分析，对抗凝情况及华法林敏感性指数（WSI）进行比较。结果 抗凝情况的分析结果显示，从第三日起试验组的凝血酶原时间国际标准化比值（INR）显著高于对照组（P < 0.05）。根据肾功能水平分层分析的结果显示，除肌酐清除率为 0 ～ 30 m L·min^{- 1}的亚组外，其余亚组中试验组的 INR 在治疗范围内的时间百分比（TTR）平均水平及 TTR > 0 的患者比例均显著高于对照组（P < 0.05）。对 WSI 进行分析，整体研究结果显示，试验组的 WSI 显著高于对照组（P < 0.05）。根据肾功能水平分层分析，不同肌酐清除率水平之间 WSI 存在显著差异（P < 0.001）。除肌酐清除率为 0 ～ 30 m L·min^{- 1}亚组外，其余亚组中试验组的 WSI 显著高于对照组，试验组 WSI 比对照组提高 16% ～ 31%。结论 华法林与胺碘酮之间的药物相互作用与肾功能有关，本研究为临床合理用药提供了可靠的依据。更多还原

【Abstract】 Objective To analyze the relationship between warfarin and amiodarone drug interactions and renal function and to determine the sources of heterogeneity in warfarin and amiodarone drug interaction. Methods Patients receiving a combination of warfarin and amiodarone were retrospectively studied and served as the test group, while patients receiving warfarin only （without combination of amiodarone） were taken as the control group. Stratified analysis was performed according to the level of renal function to compare the anticoagulation profile and warfarin sensitivity index （WSI）. Results Analysis of anticoagulation showed that the international normalized ratio （INR）was significantly higher in the test group than that in the control group from the third day onwards （P< 0.05）. The stratified analysis according to the level of renal function showed that the mean time in therapeutic range （TTR） and the proportion of patients with TTR greater than 0 was significantly higher in the test group than in the control group （P < 0.05）, except for the subgroup with creatinine clearance rate of 0 ～ 30 m L·min^{- 1}. The test group had a significantly higher WSI than that of the control group （P < 0.05）. Stratified comparative analysis based on the level of renal function showed significant difference in WSI among different creatinine clearance rate levels （P < 0.001）. Except for the subgroup with creatinine clearance rate of 0 ～ 30 m L·min^{- 1}, the WSI in the test group was significantly higher than that of the control group, 16% ～ 31% higher than that of the control group.Conclusion The drug interaction between warfarin and amiodarone is related to the renal function and this study provides a reliable basis for rational clinical drug use.更多还原