与阿拉伯人口中的临床算法相比,国际验证的基因引导华法林剂量算法的准确性
Amr M Fahmi1, Ahmed El Bardissy1, Mohamed Omar Saad1
1Pharmacy Department, Hamad Medical Corporation, Doha, Qatar.
Current problems in cardiology
|September 24, 2024
概括
在阿拉伯患者中,CYP2C9和VKORC1的遗传变异显著影响华法林剂量. 基因华法林剂量 (GWD) 算法提供了比单独临床剂量更准确的华法林剂量估计.
科学领域:
- 药物基因组学 药物基因组学
- 临床药理学 临床药理学
- 遗传学 是一个遗传学.
背景情况:
- 华法林是一种广泛处方的抗凝剂,治疗指数狭窄.
- 个性化的华法林剂量对于优化疗效和最大限度地降低出血风险至关重要.
- 已知遗传因素,包括CYP2C9和VKORC1基因变异,会影响华法林代谢和反应.
研究的目的:
- 调查CYP2C9*2, *3,VKORC1-1639 G>A和CYP4F2*3变体对阿拉伯人口中华法林剂量要求的影响.
- 为了比较临床华法林剂量 (CWD) 与遗传华法林剂量 (GWD) 的准确性,用于启动华法林治疗的算法.
主要方法:
- 研究了一组由130名阿拉伯患者组成的队列,开始治疗华法林.
- 对VKORC-1639 G>A,CYP2C9*2,CYP2C9*3和CYP4F2*3进行了基因定型.
- 使用CWD和GWD算法计算华法林剂量,并使用中位数绝对误差 (MAE) 和实际剂量的20%内的剂量百分比来比较它们的准确性.
主要成果:
- 减少CYP2C9功能等位基因与显著较低的每周华法林剂量相关 (p=0.006).
- 与AG和GG基因型相比,VKORC1AA基因型还需要显著较低的每周华法林剂量 (p<0.001).
- 与CWD相比,GWD算法显示MAE显著较低 (8.1与12.4相比,p<0.001).
结论:
- 在阿拉伯人口中,CYP2C9和VKORC1遗传变异是华法林剂量的重要决定因素.
- 将遗传信息与临床因素相结合,与单独临床因素相比,可以提高华法林剂量估计的准确性.
- 在这个队列中,GWD算法在华法林剂量预测方面表现优越.
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