药物基因组学导向高血压个体化用药的临床研究  

Clinical study on individualized treatment of hypertension guided by pharmacogenomics

作　　者：肖智林[1] 楚志文 杨梅[1] 谢秀梅[1] 陈美芳[1] XIAO Zhi-lin;CHU Zhi-wen;YANG Mei;XIE Xiu-mei;CHEN Mei-fang(Department of Geriatric Cardiology,National Clinical Research Center for Geriatric Disorders,Xiangya Hospital,Central South University,Changsha 410008,China)

机构地区：[1]中南大学湘雅医院老年病科,国家老年疾病临床医学研究中心,湖南长沙410008

出　　处：《中国实用内科杂志》2020年第10期850-854,共5页Chinese Journal of Practical Internal Medicine

基　　金：湖南省卫生健康委课题(C2019181)。

摘　　要：目的通过对比分析基因导向调整降压药和循证医学导向调整降压药的降压疗效差异,探讨高血压药物基因检测的临床应用价值。方法选取2018年1月至2018年12月长沙县高血压未达标患者480例,分为两组:观察组即根据基因检测调整降压药物(男184例,女200例);对照组即根据循证医学调整降压药物(男40例,女56例),干预前两组均进行24 h动态血压监测评估其血压水平,观察组采用棉签无创采集口腔黏膜的方法进行标本收集,应用PCR-荧光探针技术对五大类降压药物疗效相关基因的7个基因多态位点(CYP2D6*10、ADRB1、CYP2C9*3、AGTR1、ACE、CYP3A5*3和NPPA)进行基因检测,并根据检测结果选用最敏感同时副反应最小的降压药物,而对照组则由指定的医生根据《中国高血压防治指南2018年修订版》进行降压药物调整,观察调整方案4周后两组血压控制情况的差异。结果经调整降压药物治疗4周后,观察组的血压达标率为18.4%,收缩压降低幅度为(5.52±11.72)mmHg,舒张压降低幅度为(3.44±11.78)mmHg;对照组的血压达标率为24.4%,收缩压降低幅度为(0.92±9.14)mmHg,舒张压降低幅度为(3.56±8.50)mmHg,观察组与对照组相比,在血压达标率以及舒张压降低幅度方面无显著差异(P>0.05),但在收缩压降低幅度方面的差异具有统计学意义(P<0.01)。结论根据高血压药物基因检测调整降压用药,在收缩压降低幅度方面优于根据循证医学调整降压用药。Objective By comparing and analyzing the difference in clinical efficacy of adjusting antihypertensive drugs based on gene detection or evidence-based medicine,to reveal the clinical value of anti-hypertension drug gene detection.Methods 480 cases with uncontrolled hypertension in Changsha County From Jan to Dec of 2018 were divided into two groups:the experimental group which adjusted antihypertensive drug according to the gene detection,of which 184 cases were male,200 cases were female;the control group which adjusted antihypertensive drug based on evidence-based medicine,of which 40 cases were male,56 cases were female.Before intervention,the blood pressure of both groups was assessed by 24 hours ambulatory blood pressure test.The experimental group used noninvasive method of oral mucosa collection with cotton swabs to collect oral mucosa for collection,and 7 gene polymorphic loci associated with curative effect(CYP2D6*10,ADRB1,CYP2C9*3,AGTR1,ACE,CYP3A5*3 and NPPA)of the five major antihypertensive drugs was detected and classified by using PCR-fluorescence probe technique,according to the test result,the most sensitive of least side-effect antihypertensive drugs were selected.The control group in which antihypertensive drugs were adjusted by the designated doctor according to the"Revised Guidelines for the Prevention and Treatment of Hypertension in China 2018".The two groups were both taken antihypertensive drugs for four weeks,and the blood pressure of both groups was evaluated again by 24 hours ambulatory blood pressure test.Results After four weeks of adjusted antihypertensive therapy,the control rate of blood pressure in the experimental group was 18.4%,the decrease of systolic blood pressure was(5.52±11.72)mmHg,the decrease of diastolic blood pressure was(3.44±11.78)mmHg;the control rate of blood pressure in the control group was 24.4%,the decrease of systolic blood pressure was(0.92±9.14)mmHg,and the decrease of diastolic blood pressure was(3.56±8.50)mmHg.There was significant difference in the de

关 键 词：高血压 基因检测 动态血压监测 个体化治疗 

分 类 号：R544.1[医药卫生—心血管疾病]