不同CYP2 C9及GGCX基因型在人工瓣膜置换术后的抗凝效果比较

Anticoagulation effect among patients with different CYP2 C9and GGCX gentypes who received mechanical heart valve prostheses replacement

摘要:

目的了解不同CYP2C9及GGCX基因型对人工瓣膜置换术后抗凝效果的影响。方法选取2013年1月-2016年12月在该院心脏外科接受心脏瓣膜置换术的患者，采集服药后空腹12 h的外周静脉血3 ml进行CYP2 C9和GGCX基因型检测，收集患者相关临床资料，采用SPSS 21.0软件进行数据分析。结果选取80例患者， CYP2 C9基因型有2 种，包括73例CYP2C9*1*1和7例CYP2C9*1*3 患者；42例GGCX*A*G型和38例GGCX*G*G型患者。两种基因型患者在性别、年龄、体质指数（BMI）、凝血酶原时间（PT）、国家标准化比值（INR）值及达到稳定抗凝效果后的华法林血药浓度差异无统计学意义（p <0.05），但CYP2C9*1*1 型患者INR首次达标时间>CYP2C9*1*3 型患者（ p=0.013），CYP2C9*1*1型患者华法林日均稳定维持剂量>CYP2C9*1*3 型患者（p =0.011），GGCX*A*G 型患者华法林日均稳定维持剂量>GGCX*G*G 型患者（p =0.000），同时为CYP2C9*1*1 型和GGCX*A*G 型的患者华法林日均稳定维持剂量> 其他3 组（p =0.024）。CYP2 C9基因型（p =0.001）和GGCX基因型是影响患者术后第6天是否能达到治疗窗的影响因素（P =0.032）。结论根据CYP2 C9基因型和GGCX基因型确定个人使用剂量，可提高患者抗凝治疗效果。

Abstract:

Objective To investigate the impact of different genotypes of and on anticoagulative effect after prosthetic valve replacement. Methods Patients who received prosthetic valve replacement in our hospital between 2013 and 2016 were enrolled in the research, and genotypes were tested with 3 ml peripheral venous blood sample which was collected after taking medicire and fasting for 12 h and clinical data were collected for all the patients enrolled. SPSS 21.0 software was used for statistical analysis. Results Eighty patients were enrolled in this research, and two types of gene were found, including CYP2C9*1*1 in 73 patients and CYP2C9*1*3 in 7 patients. For gene, there were 42 *A*G patients and 38 GGCX*G*G patients. There was no significant difference between the two groups in the gender, age, BMI, PT, INR value, or the maintenance blood concentration of Warfarin. Honever it was longer for CYP2C9*1*1 patients to reach the first effective INR value than that of the CYP2C9*1*3 patients(p = 0.013). The daily maintenance dosage of Warfarin for CYP2C9*1*1 patients was higher than that of CYP2C9*1*3 patients (p = 0.011), and GGCX*A*G patients' daily maintenance dosage of Warfarin was higher than GGCX*G*G patients' (p = 0.000). Those patients with both CYP2C9*1*1 and GGCX*A*G needed higher daily maintenance dosage of Warfarin than others (p = 0.024). gene was a significant influencing factor associated with INR within the therapeutic window on the 6th day after operation. Conclusions Prediction of individual Warfarin dosage based on patient's gene and gene can improve the anticoagulative effect.