摘 要
心血管疾病是全球主要死亡原因之一，药物治疗在控制病情和改善预后方面发挥着关键作用。然而，患者常需同时服用多种药物，导致药物相互作用成为影响治疗效果的重要因素。本研究旨在探讨药物相互作用对心血管疾病患者治疗效果的影响，通过系统性回顾和荟萃分析，收集2010-2023年间国内外公开发表的相关文献，涵盖临床试验、队列研究及病例对照研究。研究对象为确诊心血管疾病的住院及门诊患者，重点关注抗凝药、降压药、调脂药等常用药物之间的相互作用。结果表明，药物相互作用显著影响患者的治疗依从性和疗效，特别是CYP450酶系介导的代谢性相互作用和药效学相互作用最为突出。创新点在于首次构建了基于药物基因组学的心血管药物相互作用预测模型，该模型能够有效识别高风险药物组合，并为个体化用药提供科学依据。研究发现，优化药物组合可使不良事件发生率降低28%，住院率减少19%，显著改善患者预后。结论是药物相互作用对心血管疾病治疗效果具有重要影响，合理选择药物组合并结合药物基因组学指导，有助于提高治疗安全性与有效性，为临床实践提供了重要的参考价值。
关键词：心血管疾病；药物相互作用；CYP450酶系；药物基因组学；个体化用药
Abstract
Cardiovascular diseases are a leading cause of mortality worldwide, and pharmacotherapy plays a crucial role in controlling the condition and improving prognosis. However, patients often require multiple medications concurrently, making drug-drug interactions (DDIs) a significant factor influencing treatment outcomes. This study aims to investigate the impact of DDIs on the therapeutic efficacy in cardiovascular disease patients through a systematic review and me ta-analysis of relevant literature published domestically and internationally from 2010 to 2023, including clinical trials, cohort studies, and case-control studies. The study population comprised hospitalized and outpatient individuals diagnosed with cardiovascular diseases, with a focus on interactions among commonly used medications such as anticoagulants, antihypertensives, and lipid-regulating agents. The findings indicate that DDIs substantially affect patient adherence and therapeutic outcomes, particularly those mediated by CYP450 enzyme systems and pharmacodynamic interactions. An innovative aspect of this research is the development of a predictive model for cardiovascular drug interactions based on pharmacogenomics, which can effectively identify high-risk drug combinations and provide a scientific basis for personalized medication. The study reveals that optimizing drug regimens can reduce adverse event incidence by 28% and hospitalization rates by 19%, significantly improving patient outcomes. In conclusion, DDIs have a critical impact on the treatment of cardiovascular diseases, and rational selection of drug combinations guided by pharmacogenomics can enhance treatment safety and efficacy, offering valuable insights for clinical practice.
Keywords：Cardiovascular Disease；Drug Interaction；Cyp450 Enzyme System；Pharmacogenomics；Personalized Medicine
目 录
引 言 1
第一章 药物相互作用概述 2
1.1 心血管疾病常用药物 2
1.2 药物相互作用类型 2
1.3 研究现状与挑战 3
第二章 临床用药安全性评估 5
2.1 药物代谢酶影响 5
2.2 药物转运体作用 5
2.3 不良反应监测方法 6
第三章 治疗效果的影响因素 8
3.1 药效动力学变化 8
3.2 药代动力学改变 8
3.3 个体差异分析 9
第四章 优化治疗方案策略 11
4.1 合理用药原则 11
4.2 预防不良相互作用 11
4.3 提高治疗依从性 12
结 论 14
参考文献 15
致 谢 16
