目的 研究基因检测指导下中国老年非瓣膜性心房颤动患者的华法林抗凝治疗的有效性和安全性。方法 所有非瓣膜性房颤患者随机分为基因检测组和对照组，基因检测组抽取患者外周静脉血用于测VKORC1、CYP2C9基因和国际标准化比值（international normalized ratio，INR），记录患者的临床资料。基因检测组根据华法林预测模型计算给药剂量，对照组经验性给药，后期两组患者均根据国际标准化比值（interna⁃ tional normalized ratio，INR）调整华法林剂量。对两组患者进行随访观察及华法林抗凝治疗质量评价。结果 基因检测组的过度抗凝和抗凝不足事件发生率均低于对照组（P < 0.05）。基因检测组前1个月、前3个月的INR值在目标范围时间（time in therapeutic range，TTR）的百分比均明显高于对照组。基因检测组的缺血性卒中事件累积发生率明显低于对照组。结论 基因检测指导下非瓣膜性房颤患者的华法林抗凝治疗可提高治疗安全性，提高平均TTR，且TTR在抗凝初期就能达到较高的水平，显著降低缺血性脑卒中事件的发生风险。

Objective To assess the effects of genotype⁃guided warfarin anticoagulation in Chinese elderly patients with nonvalvular atrial fibrillation（AF）. Methods All the nonvalvular AF patients were assigned into two group shaving their warfarin dose determined by an algorithm using genetic and clinical factors（genetic group）or the same algorithm using clinical factors only（control group）. For those in the genetic group，we also included genotypes for CYP2C9 and VKORC1.Genomic DNA was extracted from peripheral blood samplefor patients from genetic group using standard protocols. In the control group，the physicians and pharmacists determining the initial doses used the warfarin dosing algorithm to determine patients′ initial warfarin doses. Further dose adjustments in both groups used INR measurements and standard protocols. Results The incidence of over ⁃anticoagulant and under ⁃ anticoagulant events in genetic group was lower than that in control group（P < 0.05）. The percentage of INR value in the the rapeutic range（TTR）in the first 1 month and 3 months of the genome was significantly higher than that in the control group. The cumulative incidence of ischemic stroke events occurred in the genetic group was significantly lower than that in the control group. Conclusion Genotype⁃guided dosing could improve the average TTR，improve the safety of treatment，increase the average TTR and the TTR can reach a higher level in the early stage of anticoagulation and resulted in a lower risk of ischemic stroke events significantly.