Clinical Decision-making for Vitamin K-1 and K-2 Deficiency and Coronary Artery Calcification with Warfarin Therapy: are Diet, Factor Xa Inhibitors or both the Answer?

冠狀動脈鈣化被認為是缺血性心臟病及死亡的危險因子。Mönckeberg型動脈粥狀硬化是一種血管鈣化，現在有力的證據顯示這可能是維生素K缺乏所導致；維生素K-2，特別是來自於食物，像是乳酪的MK-4型式則具保護作用。維生素K拮抗劑-warfarin阻斷肝及周邊的維生素K循環，造成次發性維生素K缺乏，而引發脈管結構、骨頭、腎臟、腦及其它組織系統的副作用（例如發炎、免疫功能及腫瘤）。個體對維生素K缺乏的易感性及warfarin敏感性，部分可以基因多型性、表觀遺傳學、飲食及藥物治療所解釋。本文描述一位有心房顫動的男性病患，在過去十年一直以warfarin治療，被發現有廣泛性的冠狀動脈鈣化，因而帶出這個目前臨床管理的難題。最後提出一套推斷的建議。

關鍵字

維生素K缺乏症狀；冠狀動脈鈣化；維生素K拮抗劑治療；乳酪及納豆； apixaban

並列摘要

Coronary artery calcification is a recognised risk factor for ischaemic heart disease and mortality. Evidence is now strong that Mönckeberg's arteriosclerosis, a form of vascular calcification, can be attributable to vitamin K deficiency, but that vitamin K-2, especially the MK-4 form from foods like cheese can be protective. Warfarin blocks the recycling of hepatic and peripheral vitamin K leading to secondary vitamin K deficiency with adverse effects on vasculature, bone, kidneys, brain and other tissues and systems (inflammatory, immune function and neoplasia at least). There is individual susceptibility to vitamin K deficiency and warfarin sensitivity, partly explicable in terms of genetic polymorphisms, epigenetics, diet and pharmacotherapy. The emergence of extensive coronary calcification in a man with atrial fibrillation treated for a decade with warfarin is described by way of illustration and to raise the present clinical management conundrums. Finally, a putative set of recommendations is provided.

並列關鍵字

vitamin K deficiency syndromes ； coronary artery calcification ； warfarin therapy ； cheese and natto ； apixaban

參考文獻

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國際替代計量

Clinical Decision-making for Vitamin K-1 and K-2 Deficiency and Coronary Artery Calcification with Warfarin Therapy: are Diet, Factor Xa Inhibitors or both the Answer?

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