CYP2C9和CYP4F2基因多态性对瓣膜置换术后华法林维持剂量的影响

发布时间：2018-04-14 16:26

本文选题：瓣膜置换 + 华法林　；参考：《实用医学杂志》2017年07期

【摘要】：目的:探讨细胞色素P450酶(CYP2C9和CYP4F2)基因多态性对瓣膜置换术后华法林抗凝强度的影响。方法:选择瓣膜置换术后使用华法林抗凝患者136例,将患者分为4组:CYP2C9野生型组(CYP2C9*1*1)、CYP2C9突变型组(CYP2C9*3)、CYP4F2 rs2108622野生型组(CC)、CYP4F2 rs2108622突变型组(CT或TT),用Taq Man MGB探针法,检测CYP2C9*3位点和CYP4F2 rs2108622位点基因型。记录一般资料,华法林初始剂量和基础国际标准化比率(INR)测定结果,并进行随访;记录初始服用华法林到INR首次达标的时间、华法林达标总用量和平均每日用量。结果:CYP2C9*1*1患者比CYP2C9*3患者INR首次达标时间长、INR首次达标时所需的华法林总量、日均剂量大(P0.05)。CYP2C9和CYP4F2 rs2108622基因均变异的患者INR首次达标需要的平均时间最短,且INR首次达标时所服用的华法林总剂量和平均日用量最少,与2个基因均无变异组比较,差异有显著性(P0.05);与只有CYP2C9基因变异患者相比,INR首次达标的平均时间缩短,达标时华法林总用量减少(P0.05)。结论:CYP2C9和CYP4F2基因多态性是影响华法林维持剂量重要的遗传因素,患者用药前进行CYP2C9和CYP4F2基因型检查,预测华法林用药剂量,可减少抗凝过量的发生,缩短剂量调整的时间。
[Abstract]:Aim: to investigate the effect of cytochrome P450 enzyme CYP2C9 and CYP4F2 gene polymorphisms on the anticoagulant strength of warfarin after valvular replacement.Methods: 136 patients with warfarin anticoagulant after valvular replacement were divided into 4 groups: CYP2C9 wild-type group and CYP2C9 mutant group. The genotypes of CYP2C9*3 locus and CYP4F2 rs2108622 locus were detected by Taq Man MGB probe.To record the general data, the results of the initial dose of warfarin and the basic international standardized ratio (INR), and to follow up, and to record the time between the initial administration of warfarin and the first standard of INR, the total dosage of warfarin and the average daily dose of warfarin.Results the total amount of warfarin needed for the first time of INR in CYP2C9*3 patients was longer than that in patients with CYP2C9*3, and the average time required for the first time in INR patients with high daily average dose of P0.05N. CYP2C9 and CYP4F2 rs2108622 gene mutation was the shortest.The total dose and average daily dose of warfarin were the least when INR reached the standard for the first time, and the difference was significant compared with the two groups without gene variation (P 0.05), and the average time for the first time to reach the standard was shorter than that of the patients with CYP2C9 gene mutation only.The total dosage of warfarin was reduced to 0.05%.Conclusion the polymorphism of CYP2C9 and CYP4F2 gene is an important genetic factor affecting the maintenance dose of warfarin. The genotypes of CYP2C9 and CYP4F2 were detected before administration of warfarin to predict the dosage of warfarin, which can reduce the occurrence of anticoagulant overdose and shorten the time of dose adjustment.
【作者单位】：解放军305医院干部病房;解放军305医院心胸外科;首都医科大学护学院分院;
【基金】：解放军305医院重点科研基金项目(编号:12YA01)
【分类号】：R654.2

【参考文献】