Application of Gene Detection for Individualized Medication for Hypertension in Patients with Grade 3 Hypertension
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摘要:
目的 探讨应用高血压个体化用药基因检测能否改善高血压患者疗效。 方法 纳入Ⅲ级高血压住院患者200名,随机分为2组,一组为基因检测组,共100名患者,入院进行高血压个体化用药基因检测,然后根据基因检测结果进行针对个体化的精准降压治疗;另一组为常规治疗组,共100名患者,按照以往常规根据经验降压治疗。记录患者血压达标的时间、降压药物副作用以及住院日情况。 结果 (1)患者住院4 d内血压达标率基因检测组41% vs常规治疗组17%,药物副作用发生率基因检测组13% vs 常规治疗组27%,基因检测组均显著优于常规治疗组,差异有统计学意义(P < 0.05);(2)患者平均住院日基因检测组(5.42±3.24)d vs常规治疗组(6.26±3.43)d,基因检测组显著低于常规治疗组,差异有统计学意义(P < 0.05)。 结论 (1)高血压个体化用药基因检测能改善高血压患者疗效;(2)高血压个体化用药基因检测可缩短高血压患者平均住院日。 Abstract:Objective To explore the effectiveness of gene detection in improving individualized medication’s curative effect in patients with hypertension. Methods 200 inpatients with grade 3 hypertension were randomly divided into two groups. There were 100 patients in the gene testing group. After admission, personalized drug genetic testing was performed for hypertension, and then individualized precise antihypertensive therapy was performed according to the results of gene testing. The other group was the rontine treatment group, a total of 100 patients, according to previous conventional treatment based on experience. The time of blood pressure compliance, side effects of antihypertensive drugs and hospital stay were recorded. Results The blood pressure compliance rate of patients within 4 d in hospital was 41% in gene testing group versus 17% in rontine treatment group, and the incidence of drug side effects was 13% in gene testing group versus 27% in rontine treatment group. Gene testing group was significantly better than rontine treatment group, with statistical significance (P < 0.05). Average length of hospital stay in gene testing group (5.42±3.24) d vs rontine treatment group (6.26±3.43) d, gene testing group was significantly lower than rontine treatment group, the difference was statistically significant (P < 0.05). Conclusion Gene detection of individualized medication for hypertension can improve the curative effect of patients with hypertension and shorten the average hospital stay of patients with hypertension. -
Key words:
- Hypertension /
- Gene detection /
- Average hospital stay
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表 1 检测基因及位点
Table 1. Detection of genes and loci
药物种类 基因及位点 与药物关系
β受体阻滞剂CYP2D6*10 代谢酶 ADRB1 作用靶点
血管紧张素Ⅱ受体拮抗剂
(不含氯沙坦)CYP2C9*3 代谢酶 AGTR1 作用靶点
氯沙坦CYP2C9*3 代谢酶 AGTR1 作用靶点 血管紧张素转换酶抑制剂 ACE 作用靶点 钙离子拮抗剂 CYP3A5*3 代谢酶 NPPA 作用靶点 利尿剂 NPPA 作用靶点 表 2 2组患者的临床特征[
$ \bar x \pm s $ /n(%)]Table 2. Clinical features in 2 groups[
$ \bar x \pm s $ /n(%)]临床特征 基因检测组 (n = 100) 常规治疗组(n = 100) t/χ2 P 年龄(岁) 43.74 ± 7.59 42.63 ± 8.41 0.462 0.804 月收入(人民币,元) 3676.98 ± 1284.46 3566.41 ± 1743.43 0.751 0.684 男性 58(58.0) 61(61.0) 0.249 0.628 已婚 88(88.0) 86(86.0) 0.219 0.832 文化程度大学本科包含以上 27(27.0) 25(25.0) 1.051 0.689 高血压病年限(a+) 12.21 ± 10.59 13.58 ± 9.87 0.754 0.768 糖尿病 24(24.0) 23(23.0) 1.462 0.702 吸烟 32(32.0) 29(29.0) 1.507 0.694 高血压病家族史 54(54.0) 57(57.0) 1.257 0.573 四氢叶酸还原酶TT基因型 14(14.0) 12(12.0) 0.984 0.702 ALT(U) 35.1 ± 15.56 35.8 ± 14.25 0.742 0.754 AST(U) 36.7 ± 11.28 37.9 ± 12.79 0.752 0.771 Scr(μmol/L) 68.2 ± 18.19 66.4 ± 16.84 0.771 0.679 TC(mmol/L) 4.63 ± 0.91 4.72 ± 0.89 0.871 0.702 TG(mmol/L) 1.62 ± 0.62 1.69 ± 0.74 0.782 0.732 左心室射血分数(%) 40.29 ± 14.42 41.29 ± 13.25 0.782 0.761 左心室舒张末期内径(mm) 50.31 ± 6.27 51.31 ± 7.17 0.883 0.902 表 3 2组患者的合并用药情况[n(%)]
Table 3. combination features [n(%)]
合并用药 基因检测组
(n=100)常规治疗组
(n=100)χ2 P 调脂药物 43(43.0) 47(47.0) 1.284 0.562 安眠药物 26(26.0) 23(23.0) 1.563 0.784 止痛药物 7(7.0) 8(8.0) 0.862 0.654 抗焦虑药 11(11.0) 14(14.0) 0.912 0.703 降糖药物 21(21.0) 20(20.0) 1.014 0.853 表 4 2组患者住院期间血压情况[n(%)]
Table 4. Blood pressure of the two groups during hospitalization [n(%)]
达标住院天数 基因检测组 (n = 100) 常规治疗组(n = 100) χ2 P 第1天 血压监测中 血压监测中 - - 第2天 血压监测中 血压监测中 - - 第3天 13(13.0) 6(6.0) 5.284 0.012* 第4天 28(28.0) 11(11.0) 6.563 0.016* 住院前4d 41(41.0) 17(17.0) 7.862 0.009* 第5天 22(22.0) 23(23.0) 1.016 0.863 第6天 12(12.0) 18(18.0) 1.021 0.851 第7天 8(8.0) 19(19.0) 6.214 0.016* 第8天 6(6.0) 7(7.0) 0.987 0.985 第9天 5(5.0) 8(8.0) 0.919 0.913 第10天 6(6.0) 8(8.0) 0.897 0.981 平均住院日(d) 5.42±3.24 6.26±3.43 4.631 0.022* *P < 0.05。 表 5 药物副作用情况[n(%)]
Table 5. Side effects of drugs [n(%)]
药物副作用基因检测组
(n = 100)常规治疗组
(n = 100)χ2 P 头晕、头痛 3(3.0) 6(6.0) 0.954 0.951 恶心、呕吐 3(3.0) 5(5.0) 0.841 0.984 咳嗽、干咳 2(2.0) 4(4.0) 0.992 0.863 心悸、心慌 2(2.0) 4(4.0) 0.992 0.863 下肢水肿、麻木 2(2.0) 5(5.0) 0.872 0.851 发生低血压 1(1.0) 2(2.0) 0.931 0.994 总不良反应 13(13.0) 27(27.0) 6.452 0.018* *P < 0.05。 -
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