CYP2C19基因分型指导下奥美拉唑四联治疗幽门螺杆菌阳性慢性胃炎的研究  

Study on clinical effect of omeprazole quadruple therapy for helicobacter pylori positive chronic gastritis under guidance of CYP2C19 genotyping

作　　者：西娜[1] 赵冠人[1] 王雪明[1] 李倩[1] 张林[2] 

机构地区：[1]解放军第309医院药剂科,北京100091 [2]解放军第309医院消化科,北京100091

出　　处：《实用药物与临床》2015年第9期1027-1031,共5页Practical Pharmacy and Clinical Remedies

摘　　要：目的探讨依据细胞色素P450 2C19(CYP2C19)基因分型制定的个体化奥美拉唑四联方案治疗幽门螺杆菌(Hp)阳性慢性胃炎的疗效。方法利用DNA微阵列芯片法检测Hp阳性慢性胃炎患者的CYP2C19基因型,依据基因型选取快代谢型(EM)及中间代谢型(IM)的患者各100例,每种代谢型的患者各分为观察组50例和对照组50例。EM型和IM型的对照组患者均接受"奥美拉唑20 mg+阿莫西林1.0 g+克拉霉素0.5 g+枸橼酸铋钾220 mg,bid"的治疗方案,EM型观察组患者接受"奥美拉唑60 mg+阿莫西林1.0 g+克拉霉素0.5 g+枸橼酸铋钾220 mg,bid",IM型观察组患者接受"奥美拉唑40 mg+阿莫西林1.0 g+克拉霉素0.5 g+枸橼酸铋钾220 mg,bid",所有患者均治疗2周,停药至少4周后,比较不同组间患者胃炎症状的改善情况、临床疗效、Hp根除率及不良反应发生情况。结果 EM型患者,观察组总有效率96.00%,Hp根除率90.00%,对照组总有效率48.00%,Hp根除率44.00%,组间差异有统计学意义(P<0.01)。IM型患者,观察组总有效率96.00%,Hp根除率92.00%,对照组总有效率70.00%,Hp根除率62.00%,组间差异有统计学意义(P<0.01)。EM型与IM型的观察组间比较,各评价指标差异均无统计学意义(P>0.05),EM型与IM型的对照组间比较,IM型的总有效率和Hp根除率皆明显高于EM型(P<0.01或P<0.05)。结论 CYP2C19基因分型可以为个体化抗Hp治疗提供参考,由此制定的PPI个体化给药方案,可以更有效地根除Hp及提高治疗慢性胃炎的疗效,值得临床推荐。Objective To explore the clinical effect of individualized omeprazole quadruple therapy for helico-bacter pylori positive chronic gastritis under guidance of cytochrome P450 2C19 genotyping. Methods By DNA mi-croarray method,100 cases of extensive metabolizer patients and 100 cases of intermediate metabolizers with Hp posi-tive chronic gastritis were selected and divided into observation group and control group,50 cases in each group,respec-tively. All of the two control groups received quadruple therapy as “omeprazole 20 mg bid,amoxicillin 1. 0 g bid,clar-ithromycin 0.5 g bid and bismuth potassium citrate 220 mg bid”. The observation group of EM received therapy as＆quot;omeprazole 60 mg bid,amoxicillin 1. 0 g bid,clarithromycin 0.5 g bid and bismuth potassium citrate 220 mg bid“. The observation group of IM received therapy as ”omeprazole 40 mg bid,amoxicillin 1. 0 g bid,clarithromycin 0.5 g bid and bismuth potassium citrate 220 mg bid“. All patients were treated for 2 weeks,and at least 4 weeks after the end of treatment,the improvement of gastritis symptoms,clinical efficacy,Hp eradication rate and adverse reactions were compared between the two different groups. Results In the observation group of EM patients, the total efficiency was 96%,Hp eradication rate was 90%,but those of the control group were 48% and 44% （P〈0.01）. In the observation group of IM patients,the total efficiency was 96%,Hp eradication rate was 92%,but those of the control group were 70% and 62% （P〈0.01）. There was no significant difference in each evaluation index between the two observation groups（P〉0.05）,but the total efficiency and Hp eradication rate of IM control group were significantly higher than those of EM control group（P〈0.01 or P〈0.05）. Conclusion CYP2C19 genotyping can provide reference for the individualized anti-Hp therapy,which can improve Hp eradication and the curative effect of treating chronic gastritis more effectively,it is worthy of clinical recommendation.

关 键 词：细胞色素P4502C19 基因分型 奥美拉唑 四联治疗 幽门螺杆菌 慢性胃炎 

分 类 号：R573.3[医药卫生—消化系统]