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为探讨合并使用胺碘酮和华法林对不同的CYP2C9和VKORC1分型患者的抗凝作用的影响,本研究选取2013年6月至2016年6月南华大学附属第一医院收治的应用华法林进行抗凝的患者380例作为研究对象,收集患者病例相关数据、合并用药情况及其他临床资料,根据基因检测,将患者分为CYP2C9和VKORC1型,由于基因位点的不同又将CYP2C9型患者分为CYP2C9*1*1(347例)和CYP2C9*1*3(33例),VKORC1型患者分为VKORC1-1639GG(7例)、VKORC1-1639GA(37例)和VKORC1-1639AA(336例)。将77例合并使用华法林和胺碘酮的患者与仅使用胺碘酮的患者进行临床指标对比,并探讨胺碘酮对不同CYP2C9和VKORC1分型患者使用华法林的稳定剂量及INR值的影响。研究显示,华法林合并使用胺碘酮的患者中有2例发生出血事件,出血发生率为2.60%;未合并使用胺碘酮的患者中有30例发生出血事件,出血发生率为9.90%,显著高于合并胺碘酮患者(p<0.05)。合并使用胺碘酮的患者和未合并使用胺碘酮的患者在性别、身高、体重、体表面积、是否吸烟等方面具有统计学差异(p<0.05);两组患者在年龄、糖尿病患者比例、高血压患者比例、血脂异常患者比例、基因型表现、华法林稳定剂量及INR值方面无统计学差异(p>0.05)。因此,短期观测时间内,胺碘酮不影响CYP2C9和VKORC1分型患者对华法林的抗凝作用。
To explore the combined effects of amiodarone and warfarin on the anticoagulant effects of different CYP2C9 and VKORC1 patients, we selected the Chinese-French method from June 2013 to June 2016 in the First Affiliated Hospital of Nanhua University Lin anticoagulation patients 380 cases as the object of study to collect patients with case-related data, combined medication and other clinical data, according to the gene test, the patients were divided into CYP2C9 and VKORC1 type, due to different genetic loci and CYP2C9 patients The patients with VKORC1 were divided into VKORC1-1639GG (7 cases), VKORC1-1639GA (37 cases) and VKORC1-1639AA (336 cases), which were divided into CYP2C9 * 1 * 1 (347 cases) and CYP2C9 * 1 * . The clinical data of 77 patients with warfarin and amiodarone combined with amiodarone were compared and the stable dose and INR value of amiodarone for warfarin in patients with different CYP2C9 and VKORC1 types Impact. The study showed that warfarin combined amiodarone in patients with bleeding occurred in 2 cases, the incidence of bleeding was 2.60%; 30 cases of patients without amiodarone bleeding occurred, the incidence of bleeding was 9.90% , Significantly higher than those with amiodarone (p <0.05). There were significant differences in sex, height, body weight, body surface area and smoking status between patients with amiodarone and those without amiodarone (p <0.05). There was no significant difference between the two groups in the age, the proportion of patients with diabetes, The proportion of patients with hypertension, the proportion of patients with dyslipidemia, genotypes, warfarin stable dose and INR values were not statistically different (p> 0.05). Therefore, amiodarone did not affect anticoagulation of warfarin in patients with CYP2C9 and VKORC1 typing in the short-term observation period.