【摘要】 目的 探讨CYP3A5、CYP2C9和AGTR1基因多态性对原发性高血压患者钙离子拮抗剂(CCB)和血管紧张素Ⅱ受体拮抗剂(ARB)类药物疗效的影响。方法 将2020年9月至2021年6月在湖北省中医院就诊的使用CCB或ARB类降压药单药治疗的106原发性高血压患者纳入研究，其中72例口服CCB类降压药，46例口服ARB类降压药。收集纳入研究者基本资料和服药前后血压，每周随访。按照血压降低幅度，分为显效组、有效组、无效组。观察4周后，采用PCR熔解曲线法检测CYP3A5、CYP2C9和AGTR1基因型。对各基因的多态性及基因型对疗效的影响进行统计学分析。结果 72例口服CCB类单药的原发性高血压患者中，显效34例、有效17例、无效21例。46例口服ARB类单药的原发性高血压患者中，显效22例、有效13例、无效11例。单用CCB或ARB类药物的疗效与患者性别、年龄、身高、体重、体质量指数无关(P>0.05)。对于单用CCB类或ARB类降压药的患者，CYP3A5的基因多态性为疗效的影响因素(P<0.05),而CYP2C9和AGTR1的基因多态性不是疗效的影响因素(P>0.05)。对于单用CCB类药物的原发性高血压患者，CYP3A5*1/*3基因型比*1/*1基因型提高疗效8.973倍(P<0.05);对于单用ARB类药物的原发性高血压患者，CYP3A5*3/*3基因型的临床疗效是*1/*1基因的6.09倍(P<0.05),*1/*3基因型比*1/*1基因型提高疗效7.025倍(P<0.05)。结论 CYP3A5的基因多态性及基因型会影响CCB类和ARB类降压药物的疗效。更多还原

【Abstract】 Objective To investigate the effect of CYP3 A5,CYP2 C9 and AGTR1 gene polymorphisms on the efficacy of calcium antagonists(CCB) and angiotensin Ⅱ receptor antagonists(ARB) in patients with essential hypertension.Methods A total of 106 patients with essential hypertension who were treated with monotherapy of CCB or ARB antihypertensive drug in Hubei Provincial Hospital of TCM from September 2020 to June 2021 were enrolled in the study, among whom 72 patients received oral CCB antihypertensive drugs, and 46 patients took oral ARB antihypertensive drugs.The basic data and and blood pressure before and after taking the drug of the patients enrolled in the study were collected and followed up every week.According to the degree of blood pressure reduction, they were divided into markedly effective group, effective group and ineffective group.After 4 weeks of observation, the genotypes of CYP3 A5,CYP2 C9 and AGTR1 were detected by PCR melting curve method.Statistical analysis was performed on the effect of the polymorphisms and genotypes of each gene on the curative effect.Results Among the 72 patients with essential hypertension who received oral CCB drugs, 34 cases were markedly effective, 17 cases were effective, and 21 cases were ineffective.Among the 46 patients with essential hypertension who received oral ARB drugs, 22 were markedly effective, 13 were effective, and 11 were ineffective.The efficacy of CCB or ARB drugs alone was not related to the patient′s gender, age, height, weight or BMI(P>0.05).For patients taking CCB or ARB antihypertensive drugs alone, the gene polymorphism of CYP3 A5 was the influencing factor of curative effect(P<0.05),while the gene polymorphism of CYP2 C9 and AGTR1 was not the influencing factor of curative effect(P>0.05).For essential hypertension patients who used CCB drugs alone, the CYP3 A5*1/*3 genotype improved the efficacy by 8.973 times compared with *1/*1 genotype(P<0.05);for essential hypertension patients who used ARB drugs alone, the CYP3 A5*3/*3 genotype improved the efficacy by 6.09 times compared with *1/*1 genotype(P<0.05),and the *1/*3 genotype improved the efficacy by 7.025 times compared with *1/*1 genotype(P<0.05).Conclusion The genetic polymorphism and genotype of CYP3 A5 can affect the efficacy of CCB and ARB antihypertensive drugs.更多还原