Ruud Ellen, Holmstrøm Henrik, Bergan Stein, Wesenberg Finn
Department of Paediatrics, Rikshospitalet-Radiumhospitalet Medical Centre, Oslo, Norway.
Pediatr Blood Cancer. 2008 Mar;50(3):710-3. doi: 10.1002/pbc.21133.
Clinical management of warfarin therapy is complex, and dosing algorithms do not include genetic factors or interactions with other drugs for warfarin dose determinations. We evaluated the interaction of warfarin and CYP2C9 polymorphisms and concomitant corticosteroids in 29 children with cancer. Children with heterozygous polymorphisms of CYP2C9 achieved target INR sooner and more frequently had INR above the target level, compared to children without mutations. Children on concomitant steroids had significantly lower warfarin requirements. Thus, awareness of CYP2C9 genotype and steroid-induced responsiveness to warfarin may be important when administrating oral anticoagulation in children.
华法林治疗的临床管理很复杂，并且剂量算法在确定华法林剂量时未纳入遗传因素或与其他药物的相互作用。我们评估了29名癌症患儿中华法林与CYP2C9基因多态性及同时使用的皮质类固醇之间的相互作用。与未发生突变的患儿相比，携带CYP2C9杂合基因多态性的患儿更快达到目标国际标准化比值（INR），且更频繁地出现INR高于目标水平的情况。同时使用类固醇的患儿对华法林的需求显著降低。因此，在对儿童进行口服抗凝治疗时，了解CYP2C9基因型以及类固醇诱导的对华法林的反应性可能很重要。
