血管紧张素转化酶-插入/缺失多态性与厄贝沙坦降压效果相关性的系统评价

Systematic review of association between angiotensin converting enzyme gene-insertion/deletion polymorphisms and blood pressure response to Irbesartan

目的探讨血管紧张素转换酶-插入/缺失(ACE-I/D)多态性对厄贝沙坦临床降压效果的影响。方法计算机检索Pub Med、EMBase、中国期刊全文数据库(CNKI)、万方数据库、维普(VIP)、中国医院知识资源总库(CHKD)等中英文数据库,选取厄贝沙坦单药治疗组的原发性高血压患者为研究对象、各基因型治疗前后血压改变值作为结局指标,采用Rev Man 5.2对符合纳入排除标准的研究进行Meta分析。结果共纳入4个研究,408例原发性高血压患者,在降低舒张压疗效方面ACE-ID基因型优于DD基因型,其多态性与厄贝沙坦显著降低舒张压有关[SMD=1.91,95%CI(0.31,3.50),P<0.05]。ACE基因多态性与收缩压显著降低差异无统计学意义(P>0.05)。结论在使用厄贝沙坦的原发性高血压患者中,ID基因型患者舒张压的降低幅度优于DD基因型患者。该结论还需长期、大样本、高质量的研究进一步验证。

Objective To investigate the effect of angiotensin converting enzyme-insertion/deletion （ACE-I/D） gene polymorphisms on clinical efficacy of Irbesartan systematically. Methods The literatures were searched from the elec- tronic databases： PubMed, EMBase, CNKI, Wanfang, VIP, CHKD and so on. Patients with essential hypertension with Irbesartan monotherapy were selected as the objects of the study. The change value of blood pressure （BP） at predose and postdose of genotypes was selected as outcome indicator. Meta-analysis was performed by RevMan 5.2 software ac- cording to inclusive criteria and exclusion criteria. Results A total of 4 studies were included,including 408 essential hypertension cases, and the patients with the ACE-ID genotype showed a significantly greater reduction in diastolic blood pressure compared with the ACE-DD genotype. The ACE polymorphisms were significantly related to diastolic blood pressure when treated with the Irbesartan [SMD = 1.91, 95%CI （0.31, 3.50） P 〈 0.05], while it had no significant statistical sense to the systolic blood pressure when treated with Irbesartan. Conclusion In the Irbesartan treatment group, hypertensive patients with the ID gene type show a greater reduction in diastolic blood pressure than those withthe DD genotype. Long-term, large-scale trials and high quality researches should be carried out to further vali- date this conclusion.