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目的对比华法林剂量预测模型——国际华法林药物遗传学协会(IWPC)推荐的模型(模型1)和中国国家卫健委《药物代谢酶和药物作用靶点基因检测技术指南(试行)》推荐的模型(模型2)的剂量预测能力,探讨其临床应用价值。方法采用回顾性分析方法,对山西某院2016年度120例服用华法林且进行了CYP2C9&VKORC1基因型检测的本地区汉族患者分别采用模型1和模型2计算华法林剂量。以临床达到目标(INR 2～3)时的剂量作为最佳剂量,分析最佳剂量的影响因素,以及与2种预测模型之间的相关性。结果①CYP2C9、VKORC1基因型,性别,合并房颤和合用胺碘酮对华法林剂量的影响具有统计学意义(P<0.05);吸烟、饮酒以及合用阿司匹林对华法林剂量的影响无统计学意义(P>0.05)。②与最佳剂量的相关性,模型1(R2=0.53)高于模型2(R2=0.43),但预测剂量值在模型1、2之间差异无统计学意义(P>0.05)。结论山西省汉族患者华法林使用剂量个体差异受多种遗传因素和非遗传因素影响,模型1可能更适用于山西汉族人群的华法林剂量预测。
Abstract：AIM To compare international(International Warfarin Association of Pharmaceutical Genetics(IWPC), Model 1) and domestic(China National Health Care Committee "Technical Guidelines for Detection of Drug Metabolizing Enzymes and Drug Targets(Trial)", Model 2) warfarin dose prediction models to evaluate the difference of dose prediction ability and clinical application value. METHODS Using a retrospective analysis method, 120 Chinese Han patients who took warfarin and tested CYP2 C9 & VKORC1 genotypes in a hospital in Shanxi province in 2016 used the above two prediction models to calculate the warfarin dose. The dose was taken as the optimal dose when the clinical target INR(2-3) was reached. Statistical analysis was used to analyze the relevant influencing factors of the optimal dose and the correlation between the two predictive models and the optimal dose. RESULTS ①The effects of CYP2 C9, VKORC1 genotypes, gender, combined atrial fibrillation and combined effect of amiodarone on warfarin dose were statistically significant(P<0.05). There was no significant difference in the effect of smoking, drinking and combined effect of aspirin on warfarin dose(P>0.05). ②The correlation between model 1 and the optimal dose(R2=0.53) was higher than the correlation between model 2 and the optimal dose(R2=0.43). However, there was no statistical difference between the predicted dose values of the two models(P>0.05). CONCLUSION The individual dose difference of warfarin in Han Chinese patients in Shanxi province is affected by many genetic factors and non-genetic factors. Model 1 may be more suitable for warfarin dose prediction in Shanxi Han population.
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基本信息:
DOI：10.19577/j.1007-4406.2019.01.006
中图分类号:R969
引用信息:
[1]高伟祺,李志宏,陈维红.2种基于“基因检测指导个体化用药”的华法林剂量预测模型的预测能力比较[J].中国临床药学杂志,2019,28(01):22-27.DOI:10.19577/j.1007-4406.2019.01.006.
2019-01-25
2019-01-25