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目的探讨基因导向美托洛尔个体化治疗与常规治疗高血压病的临床疗效、安全性和经济性。方法在2005年9月至11月由社区收集的300例原发性高血压患者中随机抽取165例分入常规治疗组(165例),给予美托洛尔100mg/d,每日2次,共8周;其余135例进行β1肾上腺素能受体(β1-AR)和代谢酶细胞色素2D6(CYP2D6)基因多态性检测,将β1-AR389位携带Arg等位基因的133例患者按照CYP2D6基因表型分为弱代谢组(PM组,43例)、中等代谢组(IM组,54例)和强代谢组(EM组,36例),分别给予美托洛尔25、100、200mg/d,均分2次口服降压治疗,共随访8周,观察血压和不良反应等指标。应用成本-效果分析方法对基因导向型个体化治疗方案进行经济学评估。结果PM、IM、EM组降压总有效率均明显高于常规治疗组(P<0.05),PM组不良反应发生率明显低于常规治疗组(0对12.12%,P<0.05);成本效果分析,PM和IM组为经济学优势方案,EM组平均成本-效果比(C/E)稍高于常规治疗组(305.93对249.96),与常规治疗组相比增量成本效果比(ICER)为436.94。结论依据基因导向的前瞻性美托洛尔短期个体化降压治疗较传统给药模式更为安全、有效、经济。
Objective To investigate the clinical efficacy, safety and economy of gene-oriented metoprolol individualized treatment and routine treatment of hypertension. Methods A total of 165 patients were enrolled in the routine treatment group (165 cases) from 300 patients with essential hypertension collected from the community from September to November in 2005. Metoprolol was administered 100 mg / d twice daily, A total of 8 weeks; the remaining 135 cases of β1 adrenergic receptor (β1-AR) and metabolic enzyme cytochrome 2D6 (CYP2D6) gene polymorphism detection, the β1-AR389 Arg allele carrying 133 patients according to CYP2D6 The phenotypes of the patients were divided into two groups: low metabolizable group (PM group: 43 cases), middle metabolized group (54 cases) and strong metabolized group (36 cases) d, divided into two oral antihypertensive treatment, were followed up for 8 weeks, observed blood pressure and adverse reactions and other indicators. Applying the cost-effectiveness analysis method to conduct an economic evaluation of gene-oriented individualized treatment plan. Results The total effective rate of antihypertensive drugs in PM, IM and EM groups was significantly higher than that in routine treatment group (P <0.05). The incidence of adverse reactions in PM group was significantly lower than that in routine treatment group (0 vs 12.12%, P <0.05) Analysis, PM and IM group for the economic advantages of the program, EM group, the average cost-effectiveness ratio (C / E) slightly higher than the conventional treatment group (305.93 vs 249.96), compared with the conventional treatment group incremental cost-effectiveness ratio Is 436.94. CONCLUSIONS: Gene-oriented prospective metoprolol short-term individualized antihypertensive treatment is safer, more effective and more economical than traditional modes of administration.