摘要
目的分析基于细胞色素P4502D6(CYP2D6)及肾上腺素能受体β_(1)(ADRβ_(1))基因多态性对美托洛尔治疗高血压伴心率加快患者的指导价值。方法选取高血压伴心率加快患者100例,采用信封双盲法将患者分为对照组与干预组,各50例。两组均使用硝苯地平缓释片控制血压,使用美托洛尔控制心率。其中对照组根据患者实际症状凭经验给出美托洛尔初始药物使用剂量,初始方案不达标则逐渐调整;干预组根据患者实际症状和CYP2D6和ADRβ_(1)基因检测结果给出美托洛尔初始药物使用剂量,初始方案不达标则逐渐调整。比较对照组与干预组临床疗效和用药情况及用药不良反应发生情况,干预组不同用药剂量及不同基因型患者的心率、收缩压,干预组不同基因型患者的血药浓度。结果干预组治疗有效率96.00%高于对照组的78.00%,心率达标时间(9.35±2.17)d明显短于对照组的(12.44±3.60)d、用药剂量调整次数(2.16±0.43)次明显少于对照组的(3.58±0.79)次(P<0.05)。干预组用药不良反应总发生率6.00%低于对照组的22.00%(P<0.05)。治疗后,高剂量CG/UM(EM)、GG/UM(EM)及中剂量CC/UM(EM)基因型患者的心率和收缩压较治疗前明显降低,中剂量CG/IM、GG/IM及低剂量CC/IM基因型患者的心率较治疗前明显降低,低剂量CC/IM、CG/PM基因型患者的收缩压较治疗前明显降低(P<0.05)。治疗后,GG/UM(EM)、CC/IM、CC/PM基因型患者治疗后的血药浓度分别为(43.51±5.80)、(22.33±3.86)、(24.28±3.95)μg/ml,均高于治疗前的(28.67±4.16)、(28.64±4.75)、(39.15±7.29)μg/ml(P<0.05)。结论高血压伴心率加快患者使用美托洛尔治疗时,根据CYP2D6及ADRβ_(1)基因检测结果确定药物使用剂量能提高临床疗效、缩短患者心率达标时间,减少不良反应,具有推广价值。
Objective To analyze the value of cytochrome P4502D6(CYP2D6)andβ_(1)-adrenergic receptor(ADRβ_(1))gene polymorphisms in guidance of metoprolol treatment in patients with hypertension and increased heart rate.Methods 100 patients with hypertension and increased heart rate were selected,and divided into a control group and an intervention group using envelope double-blind method,with 50 cases in each group.Patients in both groups were treated with nifedipine sustained-release tablets to control blood pressure and metoprolol to control heart rate.The control group received initial drug doses based on their actual symptoms and experience,while those who did not meet the initial plan were gradually adjusted;The intervention group provides the initial drug dosage based on the actual symptoms of the patient and the results of CYP2D6 and ADRβ_(1) gene testing,and if the initial plan does not meet the standards,it will be gradually adjusted.The clinical efficacy and analyze the impact of CYP2D6 and ADRβ_(1) gene polymorphisms on efficacy.Compared the clinical efficacy,medication usage and occurrence of adverse drug reactions between the control group and the intervention group,as well as heart rate and systolic blood pressure in patients with different dosages and genotypes in the intervention group,and blood drug concentrations in patients with different genotypes in the intervention group.Results The treatment effective rate 96.00%of patients in the intervention group was higher than the control group's 78.00%;the time for patients to reach the target heart rate(9.35±2.17)d was significantly shorter than the control group's(12.44±3.60)d;the number of medication dose adjustments(2.16±0.43)times was significantly less than the control group's(3.58±0.79)times(P<0.05).The total incidence of adverse reactions 6.00%in the intervention group was lower than the control group's 22.00%(P<0.05).After treatment,the heart rate and systolic blood pressure of patients with high-dose CG/UM(EM),GG/UM(EM)and medium-dose CC/UM(EM)genotypes significantly decreased compared to before treatment.The heart rate of patients with medium-dose CG/IM,GG/IM and low-dose CC/IM genotypes significantly decreased compared to before treatment,and the systolic blood pressure of patients with low-dose CC/IM,CG/PM genotypes significantly decreased compared to before treatment(P<0.05).After treatment,the blood drug concentrations of patients with GG/UM(EM),CC/IM,and CC/PM genotypes were(43.51±5.80),(22.33±3.86),and(24.28±3.95)μg/ml,which were all higher than those before treatment[(28.67±4.16),(28.64±4.75),and(39.15±7.29)μg/ml](P<0.05).Conclusion When patients with hypertension and increased heart rate are treated with metoprolol,determining the drug dosage based on CYP2D6 and ADRβ_(1) gene testing results can improve clinical efficacy,shorten time to reach the target heart rate and reduce adverse reactions,which has promotional value.
作者
商庆辉
杜斌
穆林
林涛
王旭瑞
SHANG Qing-hui;DU Bin;MU Lin(Pharmacy Department,Sijing Hospital of Songjiang District,Shanghai 201601,China)
出处
《中国现代药物应用》
2026年第8期70-73,共4页
Chinese Journal of Modern Drug Application
基金
CYP2D6和ADRβ1基因多态性在美托洛尔控制高血压伴心率加快患者中剂量精准选择的应用(项目编号:22SJKJGG83)。
