论文部分内容阅读
目的:系统评价血管紧张素Ⅰ转换酶(ACE)基因插入/缺失(I/D)多态性与中国高血压患者血管紧张素转换酶抑制剂(ACEI)降压效果及咳嗽风险之间的关联性。方法:计算机检索PubMed、Embase、CNKI、CBM、VIP、WanFang Data数据库,查找ACE基因I/D多态性与ACEI降压效果及咳嗽关联性的队列研究或病例-对照研究。检索时间为各数据库建库至2016年8月20日。由2位评价者独立筛选文献、提取资料,并行文献质量评价后,采用Stata13.1软件进行统计分析。结果:纳入18个研究,合计高血压患者3 782例。Meta分析结果显示,ACE基因I/D多态性与ACEI降压效果存在关联性[降低收缩压:DD/DI:MD=-2.33,95%CI(-4.28,-0.39);DD/II:MD=-1.25,95%CI(-3.67,-5.95);DI/II:MD=-0.29,95%CI(-0.54,-0.04)。降低舒张压:DD/II:MD=-1.99,95%CI(-3.61,-0.37)],并且与ACEI所致咳嗽存在关联性[DD/DI+II:RR=0.42,95%CI(0.32,0.62);DD+DI/II:RR=0.67,95%CI(0.59,0.76);DD/II:RR=0.38,95%CI(0.28,0.51);DI/II:RR=0.66,95%CI(0.56,0.78);D/I:RR=0.61,95%CI(0.53,0.70)]。按疗程进行亚组分析,≤4周亚组ACE基因I/D多态性与ACEI降压效果存在关联性,但>4周亚组各基因型患者疗效差异无统计学意义。结论:当前证据显示ACEI对ACE DD基因型高血压患者近期降压效果最佳,远期疗效相当。ACE D等位基因携带者发生咳嗽风险较低。
OBJECTIVE: To systematically evaluate the association between angiotensin I converting enzyme (ACE) gene insertion / deletion (I / D) polymorphisms and the antihypertensive effect of angiotensin converting enzyme inhibitor (ACEI) and the risk of cough in Chinese hypertensive patients Sex. METHODS: A cohort study or case-control study was performed to search PubMed, Embase, CNKI, CBM, VIP, and WanFang Data databases for finding ACE-related I / D polymorphisms and ACEI antihypertensive effects and cough. Retrieval time for each database database until August 20, 2016. Two independent evaluators screened the literature, extracted data, and evaluated the quality of the parallel literature, then conducted statistical analysis using Stata13.1 software. RESULTS: Eighteen studies were included, totaling 3 782 hypertensive patients. Meta-analysis showed that ACE gene I / D polymorphism was associated with antihypertensive effect of ACEI [reduced systolic pressure: DD / DI: MD = -2.33, 95% CI (-4.28, -0.39) MD = -1.25, 95% CI (-3.67, -5.95); DI / II: MD = -0.29, 95% CI (-0.54, -0.04). Decreased diastolic blood pressure: DD / II: MD = -1.99, 95% CI (-3.61, -0.37)] and was associated with ACEI-induced cough [DD / DI + II: RR = 0.42, 95% CI , 0.62); DD + DI / II: RR = 0.67,95% CI (0.59,0.76); DD / II: RR = 0.38,95% CI (0.28,0.51); DI / II: RR = 0.66,95% CI (0.56, 0.78); D / I: RR = 0.61, 95% CI (0.53, 0.70)]. According to the course of subgroup analysis, ACE gene I / D polymorphism in ≤4 weeks subgroup was correlated with ACEI antihypertensive effect, but there was no significant difference in curative effect between genotypes in subgroup of> 4 weeks. CONCLUSIONS: Current evidence suggests that ACEI has the best long-term antihypertensive effect on patients with ACE DD genotypes in the near future, with comparable long-term efficacy. ACE D allele carriers have a lower risk of coughing.