维生素K抗体治疗期间的遗传多态化和重大出血风险:BLEEDS病例-队列研究
Eleonora Camilleri1, Mira Ghobreyal1, Mettine H A Bos2,3
1Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands.
Pharmacotherapy
|April 30, 2024
概括
在维生素K对抗剂使用者中,CYP4F2和VKORC1的遗传变异增加了严重出血的风险. 结合这些遗传因素,特别是CYP4F2-TT和VKORC1-AA,显著增加出血风险,建议个性化抗凝药治疗.
科学领域:
- 药物基因组学 药物基因组学
- 心血管医学 心血管医学
- 临床遗传学 临床遗传学
背景情况:
- 对于服用维生素K抗剂 (VKA) 的患者来说,严重出血是一个显著的风险,每年发生1%-3%.
- 影响VKA反应的遗传因素可能会导致出血风险,需要进一步调查.
研究的目的:
- 调查CYP2C9,CYP4F2,GGCX和VKORC1的遗传变异与VKA用户严重出血的风险之间的联系.
- 评估这些遗传变异对重大出血事件的综合影响.
主要方法:
- 使用BLEEDS队列 (16,570名VKA发起者) 采用了一个案例-队列研究设计.
- 对CYP2C9,CYP4F2,GGCX和VKORC1变种的基因定型对326例重大出血病例和978名子队列成员进行了测试.
- 使用权重考克斯回归分析来估计重大出血的危险比率.
主要成果:
- 作为CYP4F2-TT载体,对增加重大出血风险的趋势不显著 (HR 1.6).
- 组合变异,特别是CYP4F2-TT和VKORC1-AA,与大出血风险大幅增加有关 (HR 6.7).
- 携带至少两种变异基因型 (CYP2C9低代谢者,CYP4F2-TT,VKORC1-AA) 的出血风险增加了四倍.
结论:
- CYP4F2遗传多态性,特别是与VKORC1变体结合,与VKA用户大出血风险增加有关.
- 这些遗传洞察力有可能个性化VKA抗凝剂治疗,以减轻出血风险.
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