CYP2D6基因多态性对美托洛尔疗效影响的meta分析

目的 评价细胞色素P450 2D6（CYP2D6）药物代谢酶基因多态性对美托洛尔药物疗效的影响。方法 从各数据库（中国知网、维普、万方、SCIE、PubMed、Embase）检索从建库至2019年7月发表的关于CYP2D6与美托洛尔研究的文献，筛选并纳入文献进入质量评价，提取文献数据，对所有纳入文献结局指标使用RevMan 5.3进行定量meta分析。结果 共纳入文献8篇，其中具有酶活性代谢组（non-poor metabolizer，non-PM）631例，弱代谢组（poor metabolizer，PM）206例。PM组的收缩压（systolic blood pressure，SBP）降幅较non-PM组大，两者无明显差异（P=0.20）。non-PM组内比较，中速代谢组（intermediate metabolizer，IM）SBP的降幅大于强代谢组（extensive metabolizer，EM），差异有统计学意义（P=0.03）。PM组舒张压（diastolic blood pressure，DBP）的降幅大于non-PM组，差异有统计学意义（P=0.01），IM组的DBP降幅大于EM组，差异有统计学意义（P=0.02）。non-PM组心率（heart rate，HR）降幅大于PM组，差异有统计学意义（P=0.05），IM组HR降幅大于EM组（P=0.002）。结论 meta分析结果显示，PM组的降压效果优于non-PM各组（UM、EM及IM组），主要是在降DBP方面，而控制HR的疗效弱于non-PM各组。

Meta-analysis About the Effect of CYP2D6 Gene Polymorphisms on Efficacy of Metoprolol

OBJECTIVE To evaluate the effect of cytochrome P450 2D6 (CYP2D6) drug metabolic enzyme gene polymorphism on the efficacy of metoprolol. METHODS Literature on CYP2D6 and metoprolol published since the establishment of the database and end in July 2019 was searched from various databases(CNKI, VIP, Wanfang, SCIE, PubMed and Embase), and the literature was screened and included into the quality evaluation, and the literature data was extracted. RevMan 5.3 was used to conduct quantitative meta-analysis on the outcome indicators of all included literatures. RESULTS A total of 8 references were included, including 631 cases in the non-poor metabolizer(non-PM) group and 206 cases in the poor metabolizer(PM) group. The systolic blood pressure(SBP) reduction in the PM group was larger than that in the non-PM group, with no statistically significant difference(P=0.20). Comparison within the non-PM group, the SBP reduction in the intermediate metabolizer(IM) group was better than that in the extensive metabolizer(EM) group, with statistically significant difference(P=0.03). The effect of diastolic blood pressure(DBP) reduction in PM group was better than that in non-PM group, with statistically significant difference(P=0.01). The value of DBP reduction in EM group was lower than that in IM group, with statistically significant difference(P=0.02). The decreased heart rate(HR) value of non-PM group was higher than that of PM group, with statistically significant difference(P=0.05). The decreased HR value of IM group was higher than that of EM group(P=0.002). CONCLUSION The result of meta-analysis shows that the hypotensive effect of the PM group is better than that of the non-PM groups(UM, EM and IM group), mainly in decrease DBP, and the efficacy of HR control is weaker than that of the non-PM groups.