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目的:评价基因导向的华法林给药模型(pharmacogenomics-guided warfarin dosing algorithms)在华法林应用初期的安全性和有效性。方法:检索数据库,纳入随机对照试验(RCT),并评价其方法学质量,提取资料,用Revman 5.0软件进行Meta分析。结果:共纳入5篇文献,其方法学质量、研究人群等存在很大差异,可能存在较高的偏倚风险。Meta分析结果表明:华法林给药初期应用基因导向的华法林给药模型可以降低不良反应发生率[RR=0.52,95%CI(0.28,0.97),P=0.04],但由于存在异质性,故进行亚组分析;在INR治疗范围内的时间[SMD=-0.35,95%CI(-0.51,-0.18),P<0.000 01]、第一次达INR治疗范围的时间[SMD=-1.12,95%CI(-1.36,-0.89),P<0.000 01]、华法林初始剂量和稳定剂量的差值[SMD=-0.33,95%CI(-0.55,-0.11),P=0.003],PG组均要优于C组,且达到统计学意义。结论:给药初期,应用基因导向的华法林给药模型可以提高华法林给药的安全性和有效性。
OBJECTIVE: To evaluate the safety and efficacy of genetically-guided pharmacogenomics-guided warfarin dosing algorithms in the initial application of warfarin. METHODS: The databases were searched and included in a randomized controlled trial (RCT). The methodological quality was evaluated and data were extracted. Meta-analysis was performed using Revman 5.0 software. Results: A total of 5 articles were included. There was a great difference in their methodological quality, research population and so on. There may be a high risk of bias. Meta-analysis showed that the warfarin-administered warfarin administration model can reduce the incidence of adverse reactions [RR = 0.52, 95% CI (0.28, 0.97), P = 0.04] Sub-group analysis was performed; time within INR treatment range [SMD = -0.35, 95% CI (-0.51, -0.18), P <0.000 01], time to first INR treatment range [SMD = -1.12, 95% CI (-1.36, -0.89), P <0.000 01], difference between warfarin initial dose and steady dose [SMD = -0.33,95% CI (-0.55, -0.11), P = 0.003], PG group were better than C group, and reached statistical significance. CONCLUSIONS: In the early administration, the use of gene-directed warfarin administration improves the safety and efficacy of warfarin administration.