CYP2C19基因多态性对含泮托拉唑四联法治疗幽门螺杆菌疗效的影响  

Impact of CYP2C19 polymorphism on eradication of Helicobacter pylori using pantoprazole-based quadruple therapy

作　　者：黄译莹[1] 李玲玲[2] 孙环环 卫金歧[3] HUANG Yiying;LI Lingling;SUN Huanhuan;WEI Jlnqi(Department of;Pneumology,Central Laboratory;Department of Gastroenterology,the Fifth Affiliated Hospital of Sun Yat-sen University,Zhuhai 519000,China)

机构地区：[1]中山大学附属第五医院呼吸内科,珠海519000 [2]中山大学附属第五医院中心实验室,珠海519000 [3]中山大学附属第五医院消化内科,珠海519000

出　　处：《中国临床药学杂志》2018年第5期325-328,共4页Chinese Journal of Clinical Pharmacy

摘　　要：目的探讨CYP2C19基因多态性对含泮托拉唑的四联疗法治疗幽门螺杆菌(Hp)疗效的影响,并观察CYP2C19基因多态性与质子泵抑制剂药物不良反应的相关性。方法 113例经电子胃镜或14C呼气试验证实Hp阳性同时有反复的消化道症状的慢性胃炎患者,给予泮托拉唑40 mg,bid+枸橼酸铋钾220 mg,bid+左氧氟沙星片0. 5 g,qd+阿莫西林克拉维酸钾0. 914 g,bid四联疗法根除Hp,疗程10 d,疗程结束后4～6周内行14C呼气试验评估疗效。采用多聚酶链-限制性片段长度多态性方法检测CYP2C19基因多态性,并据其分组,即强代谢表型(EM)组、中间代谢表型(IM)组和弱代谢表型(PM)组。观察各组间Hp根除率、临床症状缓解情况和不良反应发生情况。结果 (1)10 d含泮托拉唑四联方案Hp总根除率为78. 8%,CYP2C19 EM型、IM型和PM型的Hp根除率分别为72. 1%、80. 0%、89. 5%,各基因型间Hp根除率差异无统计学意义(P>0. 05);(2)该四联疗法总症状缓解率为93. 8%;出现不良反应8人,总的不良反应发生率7. 07%,EM、IM和PM组不良反应发生率分别为4. 65%、1. 96%、26. 3%,组间差异有统计学意义(P <0. 01)。结论 CYP2C19基因多态性对含泮托拉唑的四联法根除Hp的疗效影响不大。有必要进行大样本的研究,并考虑更多的因素对其疗效的影响。AIM To evaluate the effect of CYP2C19 polymorphism on eradication rate of Helicobacterpylori （lip） by pantoprazole-based quadruple therapy. METHODS A total of 113 patients, who were positive for Hp infection, were treated with quadruple therapy （ pantoprazole ＋ bismuth subcitrate potassium ＋ levofloxacin ＋ amoxi- cillin-clavulanate potassium）. Subsequently, the patients were genotyped by the PCR-RFLP method for the pres- ence of CYP2C19 variant alleles. According to genetic polymorphisms, patients could be categorized into poor me- tabolizers （PMs）, heterozygous extensive metabolizers（IMs） and extensive metabolizers （EMs）. The patients were divided into 3 groups based on their genotype. The differences of eradication rate and clinical symptomatic remis- sions among 3 groups were analyzed. RESULT ①The total eradiation rate of tip was 78.8% , the eradication rates of lip in EMs, IMs and PMs were 72.1% ,80.0% and 89.5% respectively. The poor metabolizers had a highest eradication rate compared to the other 2 groups but statistically nonsignificant. ② Total remission rate was 93.8% ,8 people appeared adverse reactions, and the total incidence of adverse reactions was 7.07%. The inci- dence of adverse reactions in group EMs,IMs and PMs was 4.65% ,1.96% and 26.3% respectively, and there was a significant difference among them （ P 〈 0.05 ）. CONCLUSION The efficacy of pantoprazole-based quad-ruple therapy is little affected by CYP2C19 genotype. There still need for large sample research, and more factors that affect its curative effect should be considered.

关 键 词：CYP2C19 基因多态性 幽门螺杆菌 根除率 泮托拉唑 

分 类 号：R573[医药卫生—消化系统]