基因检测预测华法林给药剂量准确性的研究

发布时间：2018-07-16 18:35

【摘要】：目的:考察华法林IWPC预测剂量与实际剂量的相关性。方法:选取某院2014年11月至2015年8月间住院期间行华法林基因检测的患者97例,记录其基本信息和临床用药情况,利用基因测序的方法检测CYP2C9*2,*3和VKORC1 GA基因型,并利用IWPC公式预测患者华法林剂量,考察预测剂量与实际剂量相关性。结果:行基因检测的97例患者中,73例服用华法林,42例住院期间INR达标。初始预测剂量中,CYP2C9*3 AA/VKORC1 AA型实际初始剂量在预测剂量范围内的比例为81.13%(43/53例),CYP2C9*3 AC/VKORC1 AA型实际初始剂量在预测剂量范围内的比例为62.50%(5/8例),其余的基因型实际初始剂量在预测剂量范围内的比例较小。维持剂量中,预测周剂量的平均值为19.286 mg,实际维持周剂量平均值为19.958 mg,R=0.415,P=0.5620.05,预测的维持周剂量与实际维持周剂量无显著差异,且VKORC1 AA/CYP2C9*3 AC和VKORC1 AG/CYP2C9*3 AA2组中预测剂量与实际剂量相关系数分别为0.537和0.916,相关性良好。结论:基因检测预测华法林用药剂量具有一定的准确性,在初始剂量预测中,CYP2C9*3 AA/VKORC1 AA型和CYP2C9*3AC/VKORC1 AA型预测准确性较高;维持剂量预测中,CYP2C9*3 AC/VKORC1 AA和CYP2C9*3 AA/VKORC1 AG预测准确性较高,具有较高临床参考意义。
[Abstract]:Objective: to investigate the correlation between the predicted dose of warfarin IWPC and the actual dose. Methods: 97 patients with warfarin gene were selected from a hospital from November 2014 to August 2015, and their basic information and clinical drug use were recorded. The genotypes of CYP2C9O2KORGA-3 and VKORC1 were detected by gene sequencing. The IWPC formula was used to predict the warfarin dose and the correlation between the predicted dose and the actual dose was investigated. Results: 73 of 97 patients who took warfarin were treated with warfarin. The actual initial dose of CYP2C9 / 3 AAVKORC1 AA in the predicted dose range was 81.13% (43 / 53 cases), and the actual initial dose of CYP2C9 / ACVKORC1 AA was 62.50% (58 / 8) within the predicted dose range, and the actual initial dose of the remaining genotypes was in the pre-dose range of 62.50% (58 cases). The ratio within the range of the measured dose is small. In the maintenance dose, the average value of the predicted weekly dose was 19.286 mg, and the average of the actual maintenance weekly dose was 19.958 mg / min. The predicted weekly maintenance dose was not significantly different from the actual maintenance weekly dose. The correlation coefficients between predicted dose and actual dose in VKORC1 AA / CYP2C9 / 3 AC and VKORC1 AGR / CYP2C9 / 3 AA2 groups were 0.537 and 0.916, respectively. Conclusion: the prediction of warfarin dosage by gene detection has some accuracy. In the initial dose prediction, CYP2C9 / VKORC1 AA and CYP2C9 / 3AC / VKORCAA type are higher than that in maintenance dose prediction, and the accuracy of CYP2C9 / VKORCAA and CYP2C93AAVKORC1 AG prediction is higher than that of CYP2C93ACVKORCAA and CYP2C93AAKORC1 AG. It has high clinical reference significance.
【作者单位】：卫生部中日友好医院药学部;重庆新桥医院药学部;
【基金】：国家自然科学基金青年科学基金项目(编号:81401507) 中日友好医院院级科研基金资助课题(编号:2014-2-QN-18)
【分类号】：R969

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