摘要
目的分析H型高血压患者亚甲基四氢叶酸还原酶(MTHFR)基因多态性与缬沙坦联合叶酸片治疗效果的关系。方法回顾性选取2016年9月至2018年9月上海市徐汇区中心医院收治的120例高同型半胱氨酸血症高血压(H型高血压)患者作为研究对象,根据治疗方法的不同,将患者分为对照组(缬沙坦治疗)和试验组(缬沙坦联合叶酸片治疗),每组60例,检测两组患者的MTHFR基因型和血浆同型半胱氨酸(Hcy)水平,并对比两组患者的Hcy水平及血压情况。结果MTHFR基因型共分为CC、CT、TT3组,试验组与对照组患者基因型频率差异无统计学意义(χ^2=0.785,P=0.675)。所有患者中TT型基因型频率57(47.5%)显著高于CC组33(27.5%)与CT组30(25.0%),差异具有统计学意义(χ^2=10.240,P=0.001,χ^2=13.144,P=0.000)。治疗后,试验组患者CC、CT、TT基因型Hcy水平分别为(13.2±8.1)μmol/L、(12.7±7.7)μmol/L、(12.4±6.3)μmol/L与本组治疗前的(18.1±6.8)μmol/L、(17.6±5.5)μmol/L、(18.4±6.2)μmol/L相比,差异具有统计学意义(t=3.588,4.011,5.258,P=0.000);治疗后,试验组患者CC、CT、TT基因型与对照组治疗后的(16.2±5.3)μmol/L、(16.9±5.6)μmol/L、(17.1±7.4)μmol/L相比,差异同样具有统计学意义(t=-2.400,-3.417,-3.746,P=0.009,0.000,0.000);治疗后试验组收缩压、舒张压、Hcy水平分别为(128.3±7.5)mmHg、(78.1±4.8)mmHg、(13.4±6.7)μmol/L,显著优于对照组的(136.9±5.8)mmHg、(86.6±4.9)mmHg、(16.8±2.6)μmol/L,差异具有统计学意义(t=-7.026,-9.598,3.664,P=0.000)。结论3种MTHFR基因型H型高血压患者采用缬沙坦联合叶酸片治疗的临床效果并无显著差异。各基因型间Hcy水平并无显著差异。缬沙坦联合叶酸片可显著改善H型高血压患者的血压和Hcy水平,在临床中具有重要的意义。
Objective To analyze the relationship between methylenetetrahydrofolate reductase (MTHFR) gene polymorphism and the therapeutic effect of Valsartan combined with Folic acid tablets in patients with H-type hypertension. Methods 120 patients with hyperhomocysteinemia and hypertension (H-type hypertension) admitted to Xuhui Hospital,Zhongshan Hospital Affiliated to Fudan University from September 2016 to September 2018 were retrospectively selected as the study subjects. According to the different treatment methods,the patients were divided into control group (valsartan treatment) and experimental group (valsartan combined with folic acid tablets treatment),60 cases in each group. MTHFR genotype and plasma homocysteine (Hcy) levels were detected in the two groups,and Hcy levels and blood pressure were compared between the two groups. Results MTHFR genotypes were divided into CC,CT and TT groups. The frequency of TT genotype in all patients was 57 (47.5%) significantly higher than 33 (27.5%) in CC group and 30 (25.0%) in CT group (χ^ 2=10.240, P =0.001,χ^ 2=13.144, P =0.000). After treatment,the levels of CC,CT and TT genotype Hcy in the experimental group were (13.2±8.1)μmol/L,(12.7±7.7)μmol/L,(12.4±6.3)μmol/L,compared with (18.1±6.8)μmol/L,(17.6±5.5)μmol/L,(18.4±6.2)μmol/L before treatment,the differences were statistically significant ( t =3.588,4.011,5.258, P =0.000). After treatment,the genotypes of CC,CT and TT in the experimental group were also significantly different from those in the control group after treatment (16.2±5.3)μmol/L,(16.9±5.6)μmol/L,(17.1±7.4)μmol/L ( t =-2.400,-3.417,-3.746, P =0.009,0.000,0.000). After treatment,the systolic blood pressure,diastolic blood pressure and Hcy levels in the experimental group were (128.3±7.5) mmHg,(78.1±4.8) mmHg,(13.4±6.7)μmol/L respectively,which were significantly better than those in the control group (136.9±5.8) mmHg,(86.6±4.9) mmHg,(16.8±2.6)μmol/L). The difference was statistically significant ( t =-7.026,-9.598,3.664, P =0.000). Conclusion There was no significant difference in the clinical efficacy of valsartan combined with folic acid tablets in three MTHFR genotype H hypertension patients. There was no significant difference in Hcy levels among genotypes. Valsartan combined with folic acid tablets can significantly improve blood pressure and Hcy levels in patients with H-type hypertension,which has important clinical significance.
作者
沈婷婷
汪思阳
张娴
沈展
SHEN Ting-ting;WANG Si-yang;ZHANG Xian(Department of Geriatrics,The Central Hospital of Xuhui District,Shanghai 200031,China)
出处
《临床和实验医学杂志》
2019年第13期1407-1410,共4页
Journal of Clinical and Experimental Medicine
基金
上海市卫生和计划生育委员会课题(编号:201640173)
徐汇区中心医院院级课题支持项目(编号:2015XHYY-05)
