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基因检测指导下左心辅助装置植入术后患者华法林的抗凝效果及影响因素分析
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| 篇名： | 基因检测指导下左心辅助装置植入术后患者华法林的抗凝效果及影响因素分析 |
| TITLE： | Analysis of the anticoagulant effect and influencing factors of warfarin in patients after left ventricular assist device implantation guided by gene test |
| 摘要： | 目的 评估左心辅助装置（LVAD）植入术后患者在基因检测指导下服用华法林抗凝治疗的有效性和安全性，并分析华法林抗凝效果的影响因素。方法选择2023年1月至2024年10月在江苏省苏北人民医院心脏大血管中心接受LVAD植入术且需服用华法林抗凝治疗的患者为研究对象，根据其是否进行CYP2C9和VKORC1基因检测分为基因检测组（n＝51）和经验给药组（n＝17）。基因检测组依据基因检测计算出的预测剂量给予华法林，经验给药组由临床医生根据国际标准化比值（INR）经验性地给予华法林，每天1次。随访观察6个月，比较两组患者华法林治疗的有效性[治疗目标范围内的时间百分比（TTR）、首次达到治疗INR所需的时间、栓塞事件发生率、INR＜1.5事件发生率]和安全性（大、小出血事件和INR＞3.5事件发生率）。根据患者TTR是否≥60%分为TTR≥60%组（n＝20）和TTR＜60%组（n＝48），采用单因素和多因素二元Logistic回归分析法分析患者华法林抗凝效果的影响因素。结果基因检测组患者的TTR显著高于经验给药组（P＜0.05），INR＜1.5事件发生率显著低于经验给药组（P＜0.05）；小出血事件发生率和INR＞3.5事件发生率均低于经验给药组，但差异均无统计学意义（P＞0.05）。多因素二元Logistic回归分析结果显示，进行基因检测为华法林抗凝治疗的独立保护因素[比值比（OR）＝10.842，95%置信区间（CI）：1.211～27.037，P＝0.033]，联用他汀类药物为华法林抗凝治疗的独立危险因素[OR＝0.196，95%CI：0.045～0.861，P＝0.031]。结论对于LVAD植入术后患者，基因检测指导下采用华法林抗凝治疗可提高TTR，缩短抗凝达标时间，且安全性良好；但需注意，他汀类药物联用可能增强华法林的抗凝效果，从而增加患者出血风险。 |
| ABSTRACT： | OBJECTIVE To evaluate the effectiveness and safety of warfarin anticoagulation therapy guided by gene test in patients undergoing left ventricular assist device （LVAD） implantation， and to analyze the influencing factors of warfarin anticoagulation efficacy. METHODS Patients who underwent LVAD implantation at the Heart and Vascular Center of Northern Jiangsu People’s Hospital from January 2023 to October 2024 and required warfarin anticoagulant therapy were selected as the study subjects. They were divided into genetic testing group （n＝51） and empirical treatment group （n＝17） based on whether they underwent CYP2C9 and VKORC1 gene test. The gene test group was given warfarin based on the predicted dose calculated by gene test， while the empirical treatment group was given warfarin by clinical doctors based on international normalized ratio （INR） experience， all patients were given warfarin once a day. Follow-up observation was conducted for 6 months to compare the effectiveness [time in therapeutic range（TTR）， the time required to reach INR for the first time， the incidence of embolic events， the incidence of INR＜1.5 events] and safety （the incidence of major and minor bleeding events，the incidence of INR＞3.5 events） of warfarin treatment between two groups of patients. According to whether the patient’s TTR was ≥60%， they were divided into TTR≥60% group （n＝20） and TTR＜60% group （n＝48）. Univariate and multivariate binary Logistic regression analysis were used to determine the factors affecting the anticoagulant effect of warfarin in patients. RESULTS The TTR of patients in the gene test group was significantly higher than that in the empirical treatment group （P＜0.05）. The incidence of INR＜1.5 events in the gene test group was significantly lower than in the empirical treatment group （P＜0.05）. The incidence of minor bleeding events and INR＞3.5 events in the gene test group were lower than in the empirical treatment group， but the difference was not statistically significant （P＞0.05）. The results of multivariate binary Logistic regression analysis showed that gene test was an independent protective factor for warfarin anticoagulant therapy [odds ratio （OR）＝10.842， 95% confidence interval （CI）： 1.211-27.037， P＝0.033]， and the combination of statins was an independent risk factor for warfarin anticoagulant therapy [OR＝0.196， 95%CI： 0.045-0.861， P＝0.031]. CONCLUSIONS Under the guidance of gene test， warfarin anticoagulation therapy for LVAD patients after implantation can improve TTR， shorten the anticoagulation target time， and has good safety； meanwhile， it should be noted that the combination of statins may enhance the anticoagulant effect of warfarin， thereby increasing the risk of bleeding in patients. |
| 期刊： | 2025年第36卷第17期 |
| 作者： | 王英；李进；赵思佳；陈涛；唐程斌；刘佳 |
| AUTHORS： | WANG Ying，LI Jin，ZHAO Sijia，CHEN Tao，TANG Chengbin，LIU Jia |
| 关键字： | 华法林；左心辅助装置；基因检测；抗凝；国际化标准比值 |
| KEYWORDS： | warfarin； left ventricular assist device； gene test； anticoagulation； international normalized ratio |
| 阅读数： | 7 次 |
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