目的基于Meta分析评价β_(1)肾上腺素受体(ADRB1)389位点(rs 1801253)基因多态性对比索洛尔疗效的影响。方法通过计算机检索中国知网、维普网、万方数据知识服务平台、Web of Science、PubMed等数据库收集关于ADRB1与比索洛尔研究的文献...目的基于Meta分析评价β_(1)肾上腺素受体(ADRB1)389位点(rs 1801253)基因多态性对比索洛尔疗效的影响。方法通过计算机检索中国知网、维普网、万方数据知识服务平台、Web of Science、PubMed等数据库收集关于ADRB1与比索洛尔研究的文献,检索时间为建库至2023年7月。研究人员对发表的文献进行筛选,并将纳入文献进入质量评价,提取文献数据,对纳入文献结局指标使用Review Manager 5.3软件进行Meta分析。结果最终纳入文献6篇,其中Gly389Gly(GG型)69例,Gly389Arg(GC型)458例,Arg389Arg(CC型)611例。在降收缩压、舒张压及控制心率疗效方面,GG与CC基因型差异无统计学意义(P=0.96,P=0.84,P=0.87),GC与CC基因型差异无统计学意义(P=0.43,P=0.35,P=0.07),GG与GC基因型差异亦无统计学意义(P=0.60,P=0.68,P=0.77)。结论在比索洛尔降压及控制心率方面,ADRB1389位点基因多态性对其疗效影响并不明显。GG、GC及CC 3个基因型之间均未发现明显差异。展开更多
The use of beta(β)-blockers during septic shock aimed at countering peripheral adrenergic stress may be justified by the early reduction in deleterious effects resulting from sympathetic overactivation,and could impr...The use of beta(β)-blockers during septic shock aimed at countering peripheral adrenergic stress may be justified by the early reduction in deleterious effects resulting from sympathetic overactivation,and could improve the prognosis of patients in septic shock.Animal studies have demonstrated either a maintenance or increase in cardiac output(CO)despite the decrease in heart rate(HR)associated with improved myocardial performance.The mechanism by which𝛽-blockers alter hemodynamics in septic shock is debated;however,preclinical and clinical data show that𝛽-blockers are safe when started at a low dose.Recent publications(2019-2021)on adrenergic𝛽1 receptor antagonists used in septic shock indicate that esmolol and landiolol should not be used in the early phase.While there is no optimal timing for their administration,a minimum of 12 h after the initiation of vasopressor therapy in stabilized euvolemic patients is a reasonable option.Patients should have a normal cardiac function,although a slight depression is compatible with landiolol use under hemodynamic monitoring.Slow titration in patients who remain tachycardic is preferable to rapid titration.When used to decrease HR,landiolol is also effective in reducing the incidence of new arrhythmias.Results of a well-performed and well-powered randomized controlled trial(RCT)demonstrating a positive effect on survival-or at least on hard surrogates such as the incidence/duration of organ failure-are pending.展开更多
文摘The use of beta(β)-blockers during septic shock aimed at countering peripheral adrenergic stress may be justified by the early reduction in deleterious effects resulting from sympathetic overactivation,and could improve the prognosis of patients in septic shock.Animal studies have demonstrated either a maintenance or increase in cardiac output(CO)despite the decrease in heart rate(HR)associated with improved myocardial performance.The mechanism by which𝛽-blockers alter hemodynamics in septic shock is debated;however,preclinical and clinical data show that𝛽-blockers are safe when started at a low dose.Recent publications(2019-2021)on adrenergic𝛽1 receptor antagonists used in septic shock indicate that esmolol and landiolol should not be used in the early phase.While there is no optimal timing for their administration,a minimum of 12 h after the initiation of vasopressor therapy in stabilized euvolemic patients is a reasonable option.Patients should have a normal cardiac function,although a slight depression is compatible with landiolol use under hemodynamic monitoring.Slow titration in patients who remain tachycardic is preferable to rapid titration.When used to decrease HR,landiolol is also effective in reducing the incidence of new arrhythmias.Results of a well-performed and well-powered randomized controlled trial(RCT)demonstrating a positive effect on survival-or at least on hard surrogates such as the incidence/duration of organ failure-are pending.
