Does Computer Simulation Help Facilitate Personalized Precision Medicine for the Use of Warfarin?
Does Computer Simulation Help Facilitate Personalized Precision Medicine for the Use of Warfarin?
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计算机模拟是否有助于促进华法林使用的个性化精准医疗？
DOI：
10.1161/circgenetics.117.001969
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发表时间：
2017
期刊：
影响因子：
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通讯作者：
Goto S and Goto S
中科院分区：
文献类型：
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作者：
Goto S;Merrill P;Wallentin L;Wojdyla DM;Hanna M;Avezum A;Easton JD;Harjola VP; Huber K;Lewis BS9;Yabushita H and Goto S;Goto S and Goto S
2 Goto and Goto模拟能促进精准医学吗？基于随机临床试验结果的医学(循证医学)和未来预期的基于构造性逻辑的纯精准医学。Ravvaz等人提出的方法创建了一个基于药效学和药代动力学的模拟模型，该模型来自一个由真实患者组成的现有队列。该模型允许根据年龄、性别、种族、遗传信息等参数计算结果，并可以生成模拟实际患者的化身。因此，该模型允许我们根据需要准备尽可能多的虚拟临床试验参与者，并允许我们执行大量的虚拟临床试验来测试多个临床假设。然而，Ravvaz等人提出的模型目前只包含简单的参数。还有许多其他可能影响PT-INR控制的因素，如很少使用的药物摄入，细菌感染等。此外，在该模型中，华法林摄入量的结果的计算大大简化。PT-INR和临床结果都应该受到复杂的基于细胞的凝血的影响，10这在这个模型中没有实现。Ravvaz等人在本文中报告的方法很有趣，但这只是一个简单的开始。预计未来这一领域的研究将会扩大。
2 Goto and Goto Does Simulation Facilitate Precision Medicine? randomized clinical trial results–based medicine (evidencebased medicine) and the future expected pure precision medicine based on the constructive logic. The method Ravvaz et al1 has proposed creates a simulation model based on pharmacodynamics and pharmacokinetics from an existing cohort composed of real patients. This model allows calculation of outcomes from parameters, such as age, sex, race, genetic information, etc., and can produce avatars that mimic the actual patients. Thus, the model allows us to prepare as many participants in virtual clinical trials as we need and allows us to perform enormous numbers of virtual clinical trials testing multiple clinical hypothesis. However, the model proposed by Ravvaz et al1 currently includes only simple parameters. There are many other factor potentially influencing PT-INR control, such as rarely used drug intake, bacterial infection, etc. Furthermore, the calculation of outcomes from warfarin intakes is greatly simplified in this model. Both PT-INR and clinical outcome should be influenced by complicated cell-based coagulation, 10 which was not implemented in this model. The method Ravvaz et al1 reported in this article is interesting but just the simple beginning. Future expansion of research in this area is expected.