国防精准医疗?

IF 1.4 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Bmj Military Health Pub Date : 2024-08-24 DOI:10.1136/military-2024-002721
Stuart Jon Armstrong, K King, G Steventon
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引用次数: 0

摘要

无论是受体、转运体还是酶,蛋白质都控制着病人对药物的反应。这些蛋白质受基因控制。对这些基因以及多个基因之间相互作用的研究就是药物基因组学,单个基因被称为药物基因。对药物遗传学了解最多的是药物代谢酶,即细胞色素 P450。几乎整个英国人口都可能至少有一种基因变异控制着这些 P450s,从而控制着代谢能力的表型。这就意味着,两个接受相同药物和剂量治疗的病人可能会产生截然不同的反应,从不良反应到无效。例如,可待因、曲马多、氢可酮或羟考酮等常用 "止痛药 "的反应。这些阿片类药物通过细胞色素 2D6 代谢为活性形式。个人的代谢能力可分为四种表型:超快速、广泛、中等或较差。代谢能力差的人有可能无法从所列的阿片类药物中有效缓解疼痛,而代谢能力超快的人则有可能过度接触,进而产生依赖或滥用。在欧洲白种人群中,这些表型的流行率是众所周知的,可用于指导处方;但在尼泊尔人或太平洋岛民等其他人群中,这些表型的分布情况尚不清楚。基因分型为英国武装部队精确治疗病人和经济有效地使用药物提供了一个框架,并有可能为少数民族群体提供公平的治疗。
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Precision medicine for Defence?

Proteins control individual patient's response to pharmaceutical medication, be they receptors, transporters or enzymes. These proteins are under the control of genes. The study of these genes and the interplay between multiple genes is pharmacogenomics, with individual genes being termed pharmacogenes. The greatest understanding of pharmacogenetics is of the drug metabolising enzymes, the cytochrome P450s. Almost the entire UK population is likely to have at least one genetic variant that controls these P450s and thus the phenotype for metabolic competence. This means two patients receiving the same medication and dose may have very different responses, from adverse reaction to being ineffective. An individual military person's response to medications can be predicted from their pharmacogenetics, as an example; the response to the commonly prescribed 'pain killers', codeine, tramadol, hydrocodone or oxycodone. These opioids are metabolised into their active forms by the cytochrome 2D6. Four phenotypes classify an individual's metabolic competency: ultra-rapid, extensive, intermediate or poor. A poor metaboliser is at risk of ineffective pain relief from one of the opioids listed, whereas an ultra-rapid metaboliser is at risk of overexposure and subsequent dependency or abuse. In white European populations, the prevalence of the phenotypes is well known and may be used to guide prescribing; however, in other populations such as Nepalese or Pacific Islander the distribution of these phenotypes is unknown. Genotyping provides a framework for the precise treatment of patients and cost-effective use of medication for the UK Armed Forces, as well as potentially providing equity for minority groups.

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来源期刊
Bmj Military Health
Bmj Military Health MEDICINE, GENERAL & INTERNAL-
CiteScore
3.10
自引率
20.00%
发文量
116
期刊最新文献
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