CYP2C9和COX-2基因多态性对非甾体类抗炎药治疗强直性脊柱炎临床疗效的影响  

Effects of CYP2C9 and COX-2 gene polymorphisms on the clinical efficacy of non steroidal anti-inflammatory drugs in the treatment of ankylosing spondylitis

作　　者：杨鑫[1,2] 皮文杰 王利元 毕德利 李涛 李素铠 YANG Xin;PI Wen-jie;WANG Li-yuan;BI De-li;LI Tao;LI Su-kai(College of Clinical Medical,North Sichuan Medical College,Nanchong,Sichuan 637100,China;Department of Orthopedics,Dianjiang County People's Hospital,Chongqing 408300,China;Department of Orthopedics,the Second Affiliated Hospital of Chongqing Medical University,Chongqing 400010,China)

机构地区：[1]川北医学院临床医学院,四川南充637100 [2]重庆市垫江县人民医院骨科,重庆408300 [3]重庆医科大学附属第二医院骨科,重庆400010

出　　处：《颈腰痛杂志》2024年第4期616-621,共6页The Journal of Cervicodynia and Lumbodynia

摘　　要：目的探讨细胞色素P450同工酶2C9(CYP2C9)和环氧化酶-2(COX-2)基因多态性对非甾体类抗炎药治疗强直性脊柱炎(AS)临床疗效的影响。方法选择2020年1月至2021年6月在该院就诊的117例AS患者作为观察组;根据“性别相同、年龄±1岁”的原则,选择同期在该院健康体检的受试者作为117例作为对照组。观察两组受试者CYP2C9*3和COX-2基因启动子区域中的1190A/G和-1195G/A基因多态性,观察AS患者治疗前后的临床资料变化,观察CYP2C9*3、COX-2-1190A/G、COX-2-1195G/A等不同基因型AS患者基于ASAS20改善标准和ASAS40改善标准的疗效是否存在差异。结果两组受试者CYP2C9*3基因型和等位基因频率差异均无统计学意义(P>0.05)。两组受试者COX-2-1290A/G基因型和等位基因频率以及COX-2-1195G/A基因型和等位基因频率的差异均存在统计学意义(P<0.05)。治疗后,AS患者晨僵持续时间、周围关节受累、指地距、枕墙距、Schober测试、ESR、CRP、BASDAI(VAS)、BASDAI≥4、BASFI(VAS)、总体评价(VAS)等指标数值均较治疗前显著降低,差异均有统计学意义(P<0.05)。117例患者中,有68例(58.12%)符合ASAS20改善标准,30例(25.64%)符合ASAS40改善标准。不同CYP2C9*3基因型(AA、AC+CC)之间的ASAS20、ASAS40改善情况差异均无统计学意义(P>0.05);不同COX-2-1290A/G基因型之间的ASAS20、ASAS40改善情况差异存在统计学意义(P<0.05),其中AA基因型患者的ASAS20和ASAS40改善率均显著高于AG+GG基因型患者(P<0.05);不同COX-2-1195G/A基因型之间的ASAS20、ASAS40改善情况差异存在统计学意义(P<0.05),其中GG+AA基因型的ASAS20和ASAS40改善率显著高于GG患者(P<0.05)。结论COX-2-1290A/G和COX-2-1195G/A多态性可增加AS患者预后不良的风险,可能是预测非甾体类抗炎药治疗AS疗效的生物学指标,而CYP2C9*3多态性与非甾体类抗炎药治疗AS疗效的关系尚有待进一步研究。Objective To investigate the effects of cytochrome P450 isozyme 2C9(CYP2C9)and cyclooxygenase-2(COX-2)gene polymorphisms on the clinical efficacy of non steroidal anti-inflammatory drugs in the treatment of ankylosing spondylitis(AS).Methods 117 patients with AS treated in our hospital from January 2020 to June 2021 were selected as the observation group.According to the principle of the same gender and age±1 year,117 subjects who underwent physical examination in our hospital in the same period were selected as the control group.The CYP2C9*3 and-1190A/G and-1195G/A gene polymorphisms in the promoter regions of COX-2 genes were observed.The changes of clinical data of AS patients before and after treatment were observed,and the differences of ASAS20 and ASAS40 in AS patients with different genotypes of CYP2C9*3,COX-2-1190A/G and COX-2-1195G/A were observed.Results There was no significant difference in CYP2C9*3 genotype and allele frequency between the two groups(P>0.05).There was significant difference in COX-2-1290A/G genotype and allele frequency between the two groups(P<0.05).There was significant difference in COX-2-1195G/A genotype and allele frequency between the two groups(P<0.05).After treatment,the duration of morning stiffness,peripheral joint involvement,finger ground distance,occipital wall distance,Schober test,ESR,CRP,BASDAI(VAS),BASDAI≥4,BASFI(VAS)and overall evaluation(VAS)of AS patients were significantly lower than those before treatment(P<0.05).Among the 117 patients,68 patients(58.12%)met the ASAS20 improvement standard and 30 patients(25.64%)met the ASAS40 improvement standard.There was no significant difference in ASAS20 and ASAS40 between different CYP2C9*3 genotypes(AA,AC+CC)(P>0.05).There was significant difference in ASAS20 and ASAS40 between different COX-2-1290A/G genotypes(P<0.05).ASAS20 and ASAS40 in patients with AA genotype were higher than those in patients with AG+GG genotype(P<0.05).There was significant difference in ASAS20 and ASAS40 between different COX-2-1195G/A genotyp

关 键 词：强直性脊柱炎 非甾体类抗炎药 环氧化酶 细胞色素P450同工酶2C9 基因多态性 

分 类 号：R593.23[医药卫生—内科学]