ACE基因插入/缺失多态性与中国原发性高血压患者ACEI降压效果及咳嗽风险关联性的Meta分析  

Association among the insertion/deletion polymorphism of ACE gene,ACEI anti-hypertensive efficacy and ACEI-related cough in Chinese essential hypertension patients:A Meta-analysis

作　　者：李露[1] 李铭扬[1] 王祥宇[1] 黄国鑫[2] 刘楚繁 艾金伟 刘福元[1] 付度关[1] 

机构地区：[1]湖北医药学院附属襄阳市第一人民医院心内科,湖北襄阳442000 [2]湖北医药学院附属襄阳市第一人民医院循证医学中心

出　　处：《临床心血管病杂志》2017年第3期251-257,共7页Journal of Clinical Cardiology

基　　金：湖北省卫生计生西医类2015-2016年度一般项目(No:WJ2015MB187)

摘　　要：目的:系统评价血管紧张素Ⅰ转换酶(ACE)基因插入/缺失(I/D)多态性与中国高血压患者血管紧张素转换酶抑制剂(ACEI)降压效果及咳嗽风险之间的关联性。方法:计算机检索PubMed、Embase、CNKI、CBM、VIP、WanFang Data数据库,查找ACE基因I/D多态性与ACEI降压效果及咳嗽关联性的队列研究或病例-对照研究。检索时间为各数据库建库至2016年8月20日。由2位评价者独立筛选文献、提取资料,并行文献质量评价后,采用Stata13.1软件进行统计分析。结果:纳入18个研究,合计高血压患者3 782例。Meta分析结果显示,ACE基因I/D多态性与ACEI降压效果存在关联性[降低收缩压:DD/DI:MD=-2.33,95%CI(-4.28,-0.39);DD/II:MD=-1.25,95%CI(-3.67,-5.95);DI/II:MD=-0.29,95%CI(-0.54,-0.04)。降低舒张压:DD/II:MD=-1.99,95%CI(-3.61,-0.37)],并且与ACEI所致咳嗽存在关联性[DD/DI+II:RR=0.42,95%CI(0.32,0.62);DD+DI/II:RR=0.67,95%CI(0.59,0.76);DD/II:RR=0.38,95%CI(0.28,0.51);DI/II:RR=0.66,95%CI(0.56,0.78);D/I:RR=0.61,95%CI(0.53,0.70)]。按疗程进行亚组分析,≤4周亚组ACE基因I/D多态性与ACEI降压效果存在关联性,但>4周亚组各基因型患者疗效差异无统计学意义。结论:当前证据显示ACEI对ACE DD基因型高血压患者近期降压效果最佳,远期疗效相当。ACE D等位基因携带者发生咳嗽风险较低。Objective：To systematically review the association among angiotension-converting enzyme（ACE）gene insertion/deletion（I/D）polymorphism,ACEI anti-hypertensive efficacy and ACEI-related cough in Chinese essential hypertension patients.Method：The PubMed,EMbase,CNKI,CBM,VIP,and WanFang databases were searched up to August 20,2016 for case-control and cohort studies.The correlation among ACE I/D polymorphism,ACEI anti-hypertensive efficacy and ACEI-related cough.Two reviewers independently screened the studies according to the inclusion and exclusion criteria and extracted data.Then Meta-analysis was conducted using Stata13.1software.Result：A total of 18case-control studies involving 3 782 hypertension patients were included.The results of Meta-analysis showed that the ACE I/D polymorphism associated with the ACEI anti-hypertensive efficacy[reducing systolic blood pressure：DD vs.DI：MD=-2.33,95%CI（-4.28,-0.39）;DD vs.II：MD=-1.25,95%CI（-3.67,-5.95）;DI vs.II：MD=-0.29,95%CI（-0.54,-0.04）;reducing diastolic blood pressure：DD vs.II：MD=-1.99,95%CI（-3.61,-0.37）],and the ACEI-related cough[DD vs.DI＋II：RR=0.42,95%CI（0.32,0.62）;DD＋DI vs.II：RR=0.67,95%CI（0.59,0.76）;DD vs.II：RR=0.38,95%CI（0.28,0.51）;DI vs.II：RR=0.66,95%CI（0.56,0.78）;D vs.I：RR=0.61,95%CI（0.53,0.70）].The results of anti-hypertensive efficacy were similar in the≤4weeks treatment group,with no statistical significance differences.Conclusion：The DD genotype hypertension patients have the most significant short-term anti-hypertensive efficacy of ACEI,but the long-term effects are similar among ACE three genotype groups.The ACE D allel carriers may have the lowest risk of ACEI-related cough.

关 键 词：肽基二肽酶A 基因多态性 血管紧张素转换酶抑制剂 高血压 咳嗽 

分 类 号：R544.1[医药卫生—心血管疾病]