下肢深静脉血栓形成患者，基因检测对华法林推荐用量的回顾性研究

发布时间：2018-12-09 08:15

【摘要】：目的:回顾性研究下肢深静脉血栓患者,根据长期血凝常规监测结果调整华法林用量至实际用药量,与快速基因检测计算出的理论用药量之间的相关性。为基因检测能较准确为华法林推荐用量提供经验和依据。方法:回顾性分析皖南医学院第一附属医院血管外科于2013.01-2015.01期间收治的下肢深静脉血栓形成患者中的单纯深静脉血栓形成患者31例(伴有高血压、糖尿病等基础疾病的除外,以尽量减少同时服用的药物对华法林代谢的影响)。于入院时,抽取外周静脉血2毫升行CYP2C9和VKORC1基因检测,然后根据检测结果,结合患者年龄、性别、身高、体重,依据国际华法林药物基因组联合会推荐的华法林IWPC模型计算公式,计算出理论用药量,登记造册。但各患者并不以基因检测计算出的理论用药量给药,而以传统的定期监测血凝常规不断调整华法林用量,等各患者(INR)维持在2-3时,登记此时的实际用药量。回顾性分析此时的实际用药量与前期基因检测的理论推荐量的关联性,了解CYP2C9和VKORC1基因检测对下肢深静脉血栓患者的华法林用量是否有指导作用及其优缺点。结果:回顾性分析发现:以传统按天定期监测血凝常规中的调整的实际用药量,与快速CYP2C9和VKORC1基因检测计算出的理论推荐量有相关性,相关性达56%。结论:1.对下肢深静脉血栓形成患者而言,CYP2C9和VKORC1基因检测计算出的理论推荐量与监测血凝常规调整的实际用药量,有相关性。CYP2C9和VKORC1基因检测可用于华法林的临床用药指导。2.CYP2C9和VKORC1基因检测,可快速出结果、快速计算出理论推荐量,省时、省力。而监测血凝常规调整实际用药量耗时长,从3-30天不等,费时、费力。总之,CYP2C9和VKORC1基因检测,可有效、快速的为下肢深静脉血栓患者提供华法林指导用量。
[Abstract]:Objective: to study retrospectively the correlation between warfarin dosage and theoretical dosage calculated by rapid gene detection in patients with deep venous thrombosis of lower extremity. To provide experience and basis for gene detection for warfarin recommended dosage. Methods: a retrospective analysis of 31 patients with simple deep venous thrombosis (DVT) of the lower extremity (with hypertension) was made in the vascular surgery department of the first affiliated Hospital of Southern Anhui Medical College in the period from January 1 to January 2013,31 patients with deep venous thrombosis of the lower extremity were treated. With the exception of diabetes and other underlying diseases, to minimize the simultaneous use of drugs on warfarin metabolism). On admission, two milliliters of peripheral venous blood were taken for the detection of CYP2C9 and VKORC1 genes, and based on the results, the patients' age, sex, height and weight were combined. According to the formula of warfarin IWPC model recommended by the International Warfarin Drug Genome Federation, the theoretical dosage was calculated and the registration was made. But each patient does not use the theoretical dosage calculated by gene detection, but adjusts warfarin dosage with the conventional routine of regular monitoring of blood coagulation, so that the actual dosage of warfarin is registered when the (INR) of each patient is maintained at 2-3. A retrospective analysis of the correlation between the actual dosage of drugs and the theoretical recommended amount of previous gene detection was made to find out whether the detection of CYP2C9 and VKORC1 gene had a guiding effect on the dosage of warfarin in patients with deep venous thrombosis of lower extremity and its merits and demerits. Results: retrospective analysis showed that the traditional daily regular monitoring of the actual dosage of the adjusted drug in the blood coagulation routine was correlated with the theoretical recommended amount of rapid CYP2C9 and VKORC1 gene detection, and the correlation was 56%. Conclusion: 1. For patients with deep venous thrombosis of lower extremity, the theoretical recommended amount calculated by CYP2C9 and VKORC1 gene detection and the actual amount of drugs used to monitor the routine adjustment of hemagglutination. CYP2C9 and VKORC1 gene detection can be used to guide warfarin clinical drug use. 2.CYP2C9 and VKORC1 gene detection can produce the results quickly and calculate the theoretical recommended quantity quickly save time and labor. However, it is time-consuming and laborious to monitor the blood coagulation routine to adjust the actual dosage, ranging from 3-30 days. In conclusion, CYP2C9 and VKORC1 gene detection can be effective and rapid to provide warfarin guidance for patients with deep venous thrombosis of lower extremity.
【学位授予单位】：皖南医学院
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R654.4

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