血管紧张素转换酶插入/缺失多态性与基因导向治疗及心室重构关系的研究

Study on the relationship between angiotensin converting enzyme insertion/deletion polymorphism and Gene guided therapy and ventricular remodeling

目的:探讨血管紧张素转换酶(ACE)基因插入(I)/缺失(D)多态性与靶向治疗的相关性及与左心室重构关系的研究。方法:选取未服用过或停服降压药物至少两周的高血压病患者100例,根据基因多态性检测结果分组:A组(D/D型)25例;B组(I/D型)22例;C组(I/I型)23例;分别给予厄贝沙坦75mg、150mg、300 mg;随机抽取25例作为常规治疗组D组,给予厄贝沙坦150mg。记录用药前后不同时间段(用药前、4周、8周、12周)血压值以及随访后左心室重构相关指标变化。结果:根据基因多态性给予不同剂量的厄贝沙坦口服,基因导向精准治疗组与常规治疗组比较,收缩压、舒张压指标均有统计学差异(P<0.05);在基因导向精准治疗组中,组间比较收缩压、舒张压无统计学差异(P>0.05)。基因导向治疗组A、B、C三组治疗随访一年后左室重构指标比治疗前明显降低,有统计学差异(P<0.05),而常规治疗组治疗前后左室重构指标无统计学差异(P>0.05),基因导向治疗组与常规治疗组比较,随访一年后左室重构各指标比较有统计学差异(P<0.05)。结论:根据个体基因型施用最佳药物剂量,评估远期对左室重构的影响,可以减少和避免不良反应的发生,保护靶器官,提高高血压病人的治疗效果。

Objective:To study the relationship between angiotensin converting enzyme(ACE)gene insertion(I)/deletion(D)polymorphism and targeted therapy and left ventricle remodeling.Methods:100patients with hypertension who had not taken or stopped taking antihypertensive drugs for at least two weeks were selected and grouped according to the results of genetic polymorphism test:Group A(D/D type)25cases;22cases in Group B(I/D);Group C(I/I type)23cases;Give Ebeishatan 75mg,150mg,300mg respectively;A randomized sample of 25cases was taken as group D of the conventional treatment group and Ebeishatan was given 150mg.Record blood pressures before treatment and after that(before treatment and after 4weeks,8 weeks,12weeks),as well as the echo changes of left ventricle remodeling index after follow-up.Results:According to the gene polymorphism,different doses of Urbesartan were given,and the systolic pressure and diastolic pressure of Gene guided precision therapy were statistically significance compared with the conventional therapy group(P<0.05),and there was no statistical difference in systolic and diastolic pressure among gene oriented precision groups(P>0.05).The left ventricular remodeling index in the gene guided precision treatment group after follow-up 1year was compared with the conventional group(P<0.05),and there was no significant difference in the left ventricular remodeling index(P>0.05)among the precise treatment groups.Conclusion:Given the best available dose of the individual according to gene polymorphism,evaluating the long-term effect on the left ventricle reconstruction,it can reduce and avoid the occurrence of adverse reactions,protect target organs,and improve the treatment effect of hypertension patients.