分子分型基础上治疗老年舒张性心力衰竭的临床观察

摘要

Objectives To explore metoprolol clinical efficacy and safty based on genotyping for elderly diastolic heart failure ( DHF) treatment.Methods We selected 120 elderly patients with DHFand adopted case and control design.The fluorescence in situ hybridization was used in this study for genotyping ofβ1 receptor gene (ADRB1) and drug metabolizing enzymes gene(CYP2D6*10)., we adjusted the metoprolol sustained-release tablets dosage depending on the type of drug metabolism type, (CYP2D6*10 genotype) and the drug-sensitive type ( ADRB1 genotype) , Then follow the subjectives for 24 weeks.And compare the differ-ences of the clinic phentypes and efficacy as well as safty between two groups.Results ①Through the personal use of different do-ses of metoprolol extended release tablets based on genotyping, for the case groups, we have observed the significant drug treatment efficiency (91.5%vs.40.0%,P<0.05) when compare with control group.②There were significant difference in the left ventricu-lar diastolic function index between two groups (P<0.05), and the extent of each index change also had significant difference ( P<0.05) .③After gene-directed therapy,the incidence of adverse events and all-cause mortality and readmission rate of the observation group were significantly lower than the control group (P<0.05).Conclusions In the application of metoprolol therapy based on genotyping for elderly diastolic heart failure, we have achieved grate drug treatment efficiency and safty among elderly pa-tients who with DHF.The result has great guiding significance for clinical treatment strategy.%目的：探索在分子分型基础上，临床应用美托洛尔治疗老年舒张性心力衰竭（ DHF ）患者的有效性和安全性。方法选取老年DHF患者120例，应用原位杂交荧光染色法进行ADRB1基因和CYP2D6*10基因的分子分型，据此采用case－control设计分组观察，分为美托洛尔个体化调整用药剂量的观察组（包括CC快代谢组、CT中间代谢组和TT慢代谢组）和常规剂量用药治疗的对照组，用药后随访24周。之后在分子分型基础上，比较两组治疗DHF患者的心脏舒张功能指标和临床疗效及用药安全性数据之间的差异。结果治疗后观察组总有效率高于对照组，差异有显著性（91．5％vs．40．0％，P＜0．05），各亚组的总有效率也显著高于对照组，差别有统计学差异（P＜0．01）；观察组及各代谢亚组分别与对照组治疗后等容舒张时间（IVRT）、E峰、A峰和E／A比值指标比较均较治疗前改善，有统计学差异（P＜0．05），且前者改变的程度较后者明显，差异亦有显著性（ P＜0．05）；而观察组及各亚组不良事件的发生率却明显低于对照组，且差异有显著性（ P＜0．05）。结论在分子分型基础上，临床应用美托洛尔个体化调整用药剂量治疗老年DHF患者，与常规用药治疗相比，不仅可以改善DHF患者的临床症状及左室舒张功能等远期预后指标，而且药物不良反应的发生率低，患者依从性好，值得临床借鉴应用。