基因检测指导难治性高血压用药有效性及安全性的系统评价

Systematic Evaluation of the Efficacy and Safety of Gene Detection in Guiding the Treatment of Refractory Hypertension

目的系统评价基因检测指导难治性高血压的用药有效性及安全性,为临床治疗难治性高血压用药提供新的用药参考。方法检索万方数据库、维普中文期刊数据库、中国知网、PubMed、EMbase、Medline、Cochrane图书馆和中国生物医学文献数据库(CBM),收集使用基因指导用药组(研究组)和常规用药组(对照组)难治性高血压的随机对照试验(RCT),检索时限为从建库之日起至2022年8月。在筛选文献,提取资料后,使用RevMan5.3软件对收缩压、舒张压、总有效率以及不良反应发生率进行荟萃分析,比较研究组和对照组在有效性及安全性方面的差异。结果共纳入24篇符合研究的文献,共计4888例患者,研究组2617例,对照组2271例,其中有3篇提到了基因检测指导难治性高血压的总有效率,有6篇提到了不良反应发生率。Meta分析结果显示,研究组收缩压和舒张压降压效果均优于对照组,差异有统计学意义[MD=-10.40,95%CI(-14.67,-6.14),P<0.00001;MD=-4.32,95%CI(-7.26,-1.38),P=0.004];研究组总有效率高于对照组,差异有统计学意义[RD=0.12,95%CI(0.03,0.21),P=0.01];研究组不良反应发生率低于对照组,差异有统计学意义[OR=0.28,95%CI(0.18,0.46),P<0.00001]。结论基因指导难治性高血压用药的疗效优于常规用药,不良反应发生率低于常规用药,因此基因检测指导可用于难治性高血压用药的临床治疗中。

Objective To systematically evaluate the efficacy and safety of gene detection in guiding the treatment of refractory hypertension,and to provide a new reference for clinical treatment of refractory hypertension.Methods Wanfang database,VIP Chinese journal database,China National Knowledge Infrastructure(CNKI),PubMed,EMbase,Medline,Cochrane Library and Chinese BioMedical Literature Database(CBM)were searched to collect randomized controlled trials(RCTs)of refractory hypertension in the gene-guided medication group(study group)and the conventional medication group(control group).The retrieval time was from the date of database establishment to August 2022.After screening the literature and extracting the data,RevMan5.3 software was used to conduct a meta-analysis of systolic blood pressure,diastolic blood pressure,total effective rate and incidence of adverse reactions,and to compare the differences in efficacy and safety between the study group and the control group.Results A total of 24 articles were included in the study,with a total of 4888 patients,2617 patients in the study group and 2271 patients in the control group.Among them,3 articles mentioned the total effective rate of genetic testing to guide refractory hypertension,and 6 articles mentioned the incidence of adverse reactions.The results of Meta-analysis showed that the antihypertensive effect of systolic blood pressure and diastolic blood pressure in the study group was better than that in the control group,and the difference was statistically significant[MD=-10.40,95%CI(-14.67,-6.14),P<0.00001;MD=-4.32,95%CI(-7.26,-1.38),P=0.004];the total effective rate of the study group was higher than that of the control group,and the difference was statistically significant[RD=0.12,95%CI(0.03,0.21),P=0.01];the incidence of adverse reactions in the study group was lower than that in the control group,and the difference was statistically significant[OR=0.28,95%CI(0.18,0.46),P<0.00001].Conclusion The efficacy of gene-guided medication for refractory hypertension is better than that of conventional medication,and the incidence of adverse reactions is lower than that of conventional medication.Therefore,gene detection guidance can be used in the clinical treatment of refractory hypertension.