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目的研究血管紧张素转换酶(ACE)基因I/D多态性和醛固酮合成酶(CYP11B2)基因-344T/C多态性与氢氯噻嗪降压疗效的关系。方法829例高血压病(EH)患者同时服用氢氯噻嗪12·5mg(1次/d),6周后资料完整的785例患者按不同ACE基因型和CYP11B2基因型分组,比较不同基因型和不同基因型组合间血压下降值有无差别。结果服用氢氯噻嗪6周后,ACE基因II、ID、DD型患者收缩压分别下降(5·1±14·8)mmHg(1mmHg=0·133kPa)、(4·8±16·3)mmHg和(9·4±15·7)mmHg,DD型患者下降值大于II、ID型患者,组间比较差异有统计学意义(P<0·00);CYP11B2基因TT、TC、CC型患者收缩压下降值分别为(5·8±16·2)mmHg、(5·5±14·9)mmHg和(7·6±16·1)mmHg,组间比较差异无统计学意义。DD+CC基因型患者收缩压下降值为(10·6±12·3)mmHg,高于其他基因型组合患者,但差异无统计学意义(P>0·05)。多因素分析结果表明DD基因型和治疗前醛固酮浓度是影响患者坐位收缩压下降的主要因素。结论ACE基因的DD型与氢氯噻嗪的降压疗效相关,CYP11B2基因CC型、DD+CC型患者对氢氯噻嗪的降压反应可能优于其他基因组合患者。
Objective To investigate the relationship between angiotensin converting enzyme (ACE) gene I / D polymorphism and aldosterone synthase (CYP11B2) gene -344T / C polymorphism and hydrochlorothiazide antihypertensive effect. Methods A total of 829 hypertensive patients (EH) were treated with hydrochlorothiazide 12.5 mg once a day. After 6 weeks, 785 patients with complete data were grouped according to different ACE genotypes and CYP11B2 genotypes to compare different genotypes and different genes Type combination of blood pressure drop whether the difference. Results After six weeks of hydrochlorothiazide treatment, the systolic blood pressure of ACE gene type II, ID and DD patients decreased by 5.1 ± 14.8 mmHg (1 mmHg = 0.133 kPa), (4.8 ± 16.3) mmHg and ( 9 · 4 ± 15 · 7 mmHg, DD patients were greater than II, ID patients, the difference was statistically significant (P <0 · 00); CYP11B2 gene TT, TC, CC patients with systolic blood pressure decreased Values were (5.8 ± 16.2) mmHg, (5.5 ± 14.9) mmHg and (7.6 ± 16.1) mmHg, respectively, with no significant difference between the two groups. The systolic blood pressure in patients with DD + CC genotype decreased (10.6 ± 12.3) mmHg, higher than those in other genotypes, but the difference was not statistically significant (P> 0.05). Multivariate analysis showed that DD genotype and pre-treatment aldosterone concentration were the main factors affecting the reduction of sitting systolic pressure. Conclusion The DD genotype of ACE gene is associated with the antihypertensive effect of hydrochlorothiazide. The antihypertensive response to hydrochlorothiazide in CYP11B2 gene type CC and DD + CC patients may be superior to other gene combinations.