APOE和SLCO1B1基因多态性检测指导他汀类药物个体化临床应用的效果评价

Effect evaluation of APOE and SLCO1B1 gene polymorphisms detection for guiding the personalized clinical application of statins

目的探讨载脂蛋白E(APOE)和SLCO1B1基因多态性检测指导他汀类药物个体化临床应用的疗效和临床意义。方法以2019年1月至2020年7月招募的100例高脂血症患者作为研究对象,按照招募的顺序依次编号,单号纳入试验组,双号纳入对照组。对照组给予阿托伐他汀钙20 mg/d、每天1次的经验性治疗;试验组患者在用药之前先进行APOE和SLCO1B1基因多态性检测,根据检测结果选择适宜的他汀类药物和适宜的剂量制订初始的个体化治疗方案。服药后每2周复查两组血脂、肝功能、肌酸激酶,比较两组血脂达标率、达标时间、治疗费用,并监测药品不良反应发生情况。结果试验组治疗4周后和治疗6周后血脂符合研究方案(PP)达标率分别为91.7%和100.0%,对照组治疗4周后和治疗6周后血脂PP达标率分别为80.4%和95.0%,试验组治疗4周后和治疗6周后血脂的PP达标率均高于对照组,差异均有统计学意义(P<0.05)。治疗后试验组患者血脂平均达标时间为(31.13±4.20)d,对照组患者血脂平均达标时间为(35.00±11.01)d,两组血脂达标时间差异有统计学意义(P<0.05)。治疗6周后试验组和对照组患者AST、ALT和CK水平与治疗前相比均未发生明显改变(P>0.05),两组均未出现肌肉疼痛的不良反应,两组患者药品不良反应的发生情况差异无统计学意义(P>0.05)。去除基因检测的费用,将血脂、肝功能、CK的检查以及药品费用进行比较,试验组所有患者血脂达标时所花费的平均费用为(246.78±55.73)元,对照组为(290.41±79.26)元,两组治疗费用差异有统计学意义(P<0.05)。结论根据检测APOE和SLCO1B1基因多态性结果指导高脂血症患者个体化治疗可使患者血脂在较短时间内得到有效改善,值得临床推广。

Objective To explore the efficacy and clinical significance of APOE and SLCO1B1 gene polymorphism testing for guiding the individualized clinical application of statins.Methods One hundred patients with hyperlipidemia from January 2019 to July 2020 were recruited as the research subjects and in turn numbered according to the order of recruitment.The odd number was included in the experimental group and the even number in the control group.The control group was given the empiric therapy,atorvastatin calcium 20 mg/d,once a day.The experimental group conducted the APOE and SLCO1B1 gene polymorphisms detection before medication,and selected the appropriate statins and appropriate doses according to the detection results for formulating the initial individualized treatment scheme.The blood lipids,liver function and creatine kinase in the two groups were redetected in every two weeks after medication.The blood lipid reaching standard rate,reaching standard time and treatment cost were compared between the two groups,and the occurrence of adverse drug reactions was monitored.Results The blood lipid per-protocol(PP)reaching standard rate within 4 weeks and 6 weeks in the experimental group were 91.7%and 100.0%respectively,which in the control group were 80.4%and 95.0%respectively,the blood lipids PP reaching standard rate within 4 weeks and 6 weeks in the experimental group were higher than those in the control group,and the differences were statistically significant(P<0.05).The average reaching standard time of blood lipids in the experimental group was(31.13±4.20)d,which in the control group was(35.00±11.01)d,and the differences between the two groups were statistically significant(P<0.05).After week treatment,the levels of AST,ALT and CK in the experimental group and control group had no significant changes compaired with those before treatment(P>0.05),and no adverse reaction of myalgia occurred in both groups.There was no statistically significant difference in the incidence rate of adverse drug reactions between the two groups(P>0.05).Excluding the cost of genetic detection,in the comparison of blood lipids,liver function,CK detection and drug costs,the average cost of all patients in the experimental group when blood lipids reached the standard was(246.78±55.73)Yuan,which in the control group was(290.41±79.26)Yuan,and the difference in the treatment cost between the two groups was statistically significant(P<0.05).Conclusion Guiding the individualized treatment of the patients with hyperlipidemia according to the results of APOE and SLCO1B1 gene polymorphism can make the patients with hyperlipidemia to obtain the effective improvement of blood lipids in a short time,which is worthy of clinical promotion.