CYP2C19基因多态性对雷贝拉唑与奥美拉唑四联治疗幽门螺杆菌阳性胃溃疡疗效的影响  

Impact of CYP2C19 gene polymorphisms on clinical effect of rabeprazole and omeprazole quadruple therapy for helicobacter pylori positive gastric ulcer

作　　者：西娜[1] 赵冠人[1] 王雪明[1] 李倩[1] 

机构地区：[1]解放军第309医院药剂科,北京100091

出　　处：《临床药物治疗杂志》2015年第5期36-40,共5页Clinical Medication Journal

摘　　要：目的:分析CYP2C19基因多态性对雷贝拉唑和奥美拉唑四联治疗幽门螺杆菌(Hp)阳性胃溃疡疗效的影响。方法:选取Hp阳性胃溃疡患者168例,随机分为2组。观察组接受雷贝拉唑四联疗法,对照组接受奥美拉唑四联疗法,治疗结束4周后比较2组患者胃肠道症状改善情况、临床疗效、Hp根除率及不良反应发生情况。同时利用DNA微阵列芯片法检测患者的CYP2C19基因型,观察基因型对两组药物疗效的影响。结果:观察组治愈率72.62%,总有效率89.28%,Hp根除率95.23%,对照组治愈率58.34%,总有效率72.62%,Hp根除率86.90%,两组差异显著(P<0.05或P<0.01)。观察组中,快代谢型(EM)治愈率61.12%,中间代谢型(IM)80.00%,弱代谢型(PM)84.62%,EM型与IM及PM型间差异极显著(P<0.01),IM型与PM型之间无显著性差异(P>0.05)。对照组中,EM型治愈率44.74%,IM型64.71%,PM型83.34%,3种代谢型间的治愈率差异极显著(P<0.01)。相同代谢型患者治愈率两组间比较,PM型无明显差异(P>0.05),但EM型与IM型观察组均明显高于对照组(P<0.05)。结论:雷贝拉唑四联疗法较奥美拉唑四联疗法治疗Hp阳性胃溃疡根除率更高,疗效更显著,安全性相当,且受CYP2C19基因型影响程度较小,疗效更稳定,值得临床推荐。Objective： To investigate whether the effect of omeprazole and rabeprazole quadruple therapy on treatinghelicobacter pylori-positive gastric ulcer is related to CYP2C19 gene polymorphisms.Methods： 168 patients diagnosed ashelicobacter pylori-positive gastric ulcer were randomly divided into observation and control groups.The two groups were treated with rabeprazole and omeprazole quadruple therapy respectively. After 4-week treatment, the improvement of gastrointestinal symptoms, clinical efifcacy, Hp eradication rate and adverse reactions were compared between the two groups. The CYP2C19 genotypes of 168 patients were detected by DNA microarray method to observe the effect of genotype on curative effect of two groups.Results：In the observation group, the curative rate, total efifciency and eradication rate ofH.p. were 72.62%, 89.28% and 95.23% while those of the control group were 58.34%, 72.62% and 86.90%respectively. The differences between the two groups were signiifcant （P〈0.05 or P〈0.01）. In the observation group, the curative rates were 61.12%, 80.00% and 84.62% in EM, IM and PM patients respectively.There were signiifcant differences between EM and IM （P〈0.01）, EM and PM （P〈0.01）, but not between IM and PM （P〉0.05）. In the control group, the curative rates were 44.74%, 64.71% and 83.34% in EM, IM and PM patients respectively.The differences in three metabolic types were extremely signiifcant （P〈0.01）. The curative rates of EM and IM but not PM patients from the observation group were signiifcantly higher than that of the control group （P〈0.05）.Conclusion： The clinical efifcacy andH.p. eradication of rabeprazole quadruple therapy for Hp positive gastric ulcer were superior to omeprazole. Moreover, rabeprazole is less affected by CYP2C19 genotype and therefore its curative effect is more stable.

关 键 词：细胞色素P450 2C19 基因多态性 雷贝拉唑 奥美拉唑 四联治疗 螺杆菌 幽门 胃溃疡 

分 类 号：R573.1[医药卫生—消化系统]