| Objective:This study is based on patients with deep venous thrombosis of lower extremity in Yunnan area, and explore the clinical treatment of patients with the clinical treatment of the patients with lower limb deep venous thrombosis, which is better than the clinical experience for the treatment of the patients with better safety and drug effects.Methods:Collected in August 2014 to October 2015 Yunnan Nationality cases in the First Affiliated Hospital of Kunming Medical College of vascular surgery, and the initial treatment of deep venous thrombosis of the lower limbs formed a total of 114 cases, account for two warfarin therapy to patients, according to the wishes of patients will be above were divided into direct gene sequencing of comprehensive treatment group combined with clinical experience of the treatment group. Clinical experience of treatment group have 71 cases, male 28 cases (39.44%), female 43 cases (60.56%), and the ratio of male to female is 1:1.54, average age is 51.94±15.09 years, average height is 160.85±8.74 cm, average body mass is 6.172±10.97 Kg, the group administered with a starting dose of warfarin is 3mg, late on blood coagulation function can test results to adjust the dosage of warfarin treatment. Gene sequencing of comprehensive treatment group have 43 cases, male 18 cases (41.68%) and female 25 cases (58.14%), and the ratio of male to female is 1:1.39, average age is 5.6±12.19 years, average height is 161.30±7.32 cm and average body mass is 6.2±11.36 Kg. This group used the Chinese era of rapid gene analysis method, detection in patients with warfarin related genes CYP2C9 and VKORC1 genotypes, and combined with patient age, height, body mass, using The International Warfarin Pharmaeogenetics Cons-ortium (IWPC) formula warfarin dose were calculated, and according to the clinical examination of coagulation function result, adjust the dosage to comprehensive treatment. Followed up and recorded during hospitalization and after discharge international normalized ratio (INR) of 3 months and no adverse events occurred, the prospective comparison of two groups of lower limb deep vein thrombosis formation of warfarin therapy regimens in the treatment of safety and efficacy (including INR< 1.5 percentage, INR at 1.8 to 3.0 percentage of INR> 3.5 percentage, adverse event incidence rate), the retrospective analysis of patients with actual warfarin maintain dose and calculated the theoretical dose correlation.Result:1.The clinical experience treatment group and the combined treatment group two groups of patients in the treatment group were better than the clinical symptoms and the clinical symptoms were relieved and the thrombus ablation was not statistically significant (P> 0.05).2.The proportion of INR<1.5 in the clinical experience treatment group and the combined treatment group is similar (respectively 0.3±0.08å'Œ0.29±0.07) to the 3 months after discharge, and the difference was not statistically significant (P> 0.05).3.The proportion of INR between 1.8 and 3.0 in the clinical experience treatment group and the combined treatment group,the combined treatment group is higher than the clinical experience treatment group (respectively 0.29±0.08å'Œ0.42±0.09),the difference was statistically significant (P< 0.05).4.The proportion of INR>3.5 in the clinical experience treatment group and the combined treatment group,the combined treatment group is lower than the clinical experience treatment group (respectively 0.05±0.09å'Œ0.01±0.03),the difference was statistically significant (P<0.05).5.The rate of bleeding adverse events in the integrated treatment group was less than that of the clinical empirical therapy group (respectively 0%å'Œ7.04%), While the two groups had no thrombosis events after treatment.6.Recall, combined with genetic testing of integrated group treated with warfarin maintain dose and dose of income theory of correlation analyzing results through genetic testing,use pearson correlation test,after SPSS software calculation, the coefficient of determination R2=0.489.Conclusion:1.The formation of warfarin therapy regimens prospective comparison of two groups of lower extremity deep venous thrombosis,the proportion of INR<1.5 in the clinical experience treatment group and the combined treatment group is similar,but the proportion of INR between 1.8 and 3.0 in the clinical experience treament group and the combined treatment group,the combined treatment group is higher than the clinical experience treatment group,indicate according to a comprehensive genetic testing to warfarin treatment drug regimen is worthy of recognition;The proportion of INR>3.5 in the clinical experience treatment group and the combined treatment group,the combined treatment group is lower than the clinical experience treatment group,indicate combined with genetic testing of warfarin to the regimen of treatment is a safe clinical empirical dosing regimens to high potential risk rate is low.2.Retrospective analysis and gene detection of comprehensive treatment group were actual warfarin maintain dose and calculated the theoretical dose correlation both obtained the coefficient of determination R2=0.489,combined with genetic testing, and patient’s age, height, weight factors are considered, can be explained 48.9% of lower extremity deep venous thrombosis in patients with warfarin treatment, so treatment of lower extremity deep vein thrombosis formation testing in clinical uplink warfarin related genes have a certain predictability, is meaningful to optimize the treatment of the disease in Yunnan. |
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