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目的:评价CYP2C9和VKORC1-1639G>A不同基因型组合对华法林平均日剂量(mean daily warfarin dose,MDWD)的影响。方法:计算机检索中国期刊全文数据库(CNKI)、中国生物医学文献数据库(CBM)、万方数据库、PubMed(2007年1月-2013年7月),根据纳入标准对文献进行筛选和评估,采用RevMan 5.1软件及Stata 12.0软件对数据进行Meta分析。结果:共纳入包括998例患者在内的9篇研究,其中中文3篇,英文6篇。结果显示,与*1/*1+AA组相比,*1/*1+GG组、*1/*1+GA组和*1/*3+GA组MDWD分别升高1.01(95%CI:0.38,1.65;P=0.002),0.41(95%CI:0.15,0.68;P=0.002)和0.06个标准单位(95%CI:-0.06,0.18;P=0.31);*1/*3+AA组和*3/*3+AA组分别降低0.29(95%CI:-0.45,-0.13;P=0.000 4)和0.38个标准单位(95%CI:-0.59,-0.17;P=0.000 3)。敏感性分析表明,结果较为稳定可信。结论:本Meta分析得到CYP2C9和VKORC1-1639G>A不同基因型组合对MDWD的影响的定量结果,该结果可对华法林个体化给药提供参考。
OBJECTIVE: To evaluate the effect of different genotype combinations of CYP2C9 and VKORC1-1639G> A on mean daily warfarin dose (MDWD). Methods: CNKI, CBM, PubMed (January 2007 - July 2013) were searched by computer. According to the inclusion criteria, the literature was screened and evaluated, and RevMan 5.1 software and Stata 12.0 software Meta-analysis of the data. Results: A total of 9 studies including 998 patients were enrolled, including 3 Chinese and 6 English. The results showed that MDWD increased by 1.01 (95% CI) in * 1 / * 1 + GG group, * 1 / * 1 + GA group and * 1 / * 3 + GA group, respectively : 0.38, 1.65; P = 0.002), 0.41 (95% CI: 0.15,0.68; P = 0.002) and 0.06 standard units (95% CI: -0.06, The reduction of 0.29 (95% CI: -0.45, -0.13; P = 0.0004) and 0.38 standard units (95% CI: -0.59, -0.17; P = 0.0003 ). Sensitivity analysis shows that the results are more stable and credible. Conclusion: This Meta-analysis provides quantitative results on the MDWD effect of different combinations of genotypes CYP2C9 and VKORC1-1639G> A, which provide a reference for the individualized administration of warfarin.