CYP2C19基因多态性检测指导质子泵抑制剂四联疗法精准用药的疗效评价研究  

The Efficacy Evaluation Study of Proton Pump Inhibitor Quadruple Therapy Based on CYP2C19 Gene Polymorphism Detection

作　　者：常亮 龚慧 俞卫宁 吴晓莉 马玉玲 李祥 胡学江 CHANG Liang;GONG Hui;YU Weining;WU Xiaoli;MA Yuling;LI Xiang;HU Xuejiang(Ningxia Zhongwei Shapotou District People's Hospital,Zhongwei,Ningxia Hui Autonomous Region,755000,China;Ningxia Zhongwei Hospital of Traditional Chinese Medicine,Zhongwei,Ningxia Hui Autonomous Region,755000,China)

机构地区：[1]宁夏中卫市沙坡头区人民医院,宁夏中卫755000 [2]宁夏中卫市中医医院,宁夏中卫755000

出　　处：《中外医疗》2024年第34期61-65,共5页China & Foreign Medical Treatment

基　　金：中卫市2023年度社会发展领域重点研发计划(2023BUS53011)。

摘　　要：目的探讨通过CYP2C19基因多态性检测指导质子泵抑制剂(pump inhibitors,PPIs)四联疗法用药选择,提高幽门螺杆菌感染的根除治愈率。方法随机选取2023年2—10月宁夏中卫市沙坡头区人民医院消化内科收治的400例幽门螺杆菌(helicobacter pylori,HP)阳性感染者为研究对象,根据不同治疗方法分为对照组、研究组,各200例。其中对照组给予经验疗法,研究组应用聚合酶链反应(polymerase chain reaction,PCR)-荧光探针技术检测CYP2C19基因多态性,根据具体基因检测结果分为3个代谢类型,分别选择对应方案给予治疗,比较两组的治疗效果。结果研究组患者中,CYP2C19*1/*1正常代谢型81例(40.50%),中间代谢型91例(45.53%),慢代谢型28例(14.00%)。3种代谢型别HP感染患者治愈率:中间代谢型96.70%(88/91)最高,慢代谢组78.57%(22/28)最低,差异有统计学意义(χ^(2)=7.643,P=0.006);正常代谢组和中间代谢型、慢代谢型对比,差异均无统计学意义(P均>0.05)。研究组患者整体治愈率为91.50%(183/200),高于对照组的60.50%(121/200),差异有统计学意义(χ^(2)=7.259,P<0.05)。两组均接受泮托拉唑治疗时,对照组治愈率68.92%(51/74)低于研究组的90.12%(73/81),差异有统计学意义(χ^(2)=10.867,P<0.05);两组均接受相同剂量的奥美拉唑质子泵抑制剂时,对照组治愈率55.56%(70/126)低于研究组的92.44%(110/119),差异有统计学意义(χ^(2)=42.708,P<0.05)。结论根据CYP2C19基因多态性检测结果,选择合适的PPIs及其剂量,与经验疗法相比,可提高幽门螺杆菌感染的治愈率。Objective To improve the eradication rate of Helicobacter pylori infection by guiding the selection of pro-ton pump inhibitors(PPIs)quadruple therapy through CYP2C19 gene polymorphism detection.Methods A total of 400 patients with Helicobacter pylori(HP)positive infection admitted to the Department of Gastroenterology,Ningxia Zhong Shapotou People's Hospital from February to October 2023 were randomly selected as the research objects.Ac-cording to different treatment methods,they were divided into control group and study group,with 200 cases in each group.The control group was given empirical therapy.The study group used polymerase chain reaction(PCR)-fluores-cent probe technology to detect CYP2 C19 gene polymorphism.According to the specific gene test results,it was di-vided into three metabolic types,and the corresponding regimens were selected for treatment.The therapeutic effects of the two groups were compared.Results Among the patients in the study group,81 cases(40.50%)of CYP2C19*1/*1 normal metabolizers,91 cases(45.53%)of intermediate metabolizers,and 28 cases(14.00%)of poor metabolizers.The cure rate of HP infection in patients with three metabolic types:96.70%(88/91)in the intermediate metabolizers was the highest,and 78.57%(22/28)in the poor metabolizers was the lowest,the difference was statistically signifi-cant(χ^(2)=7.643,P=0.006);there was no significant difference between the normal metabolizers and the intermediate metabolizers and the slow metabolic group(both P>0.05).The overall cure rate of the study group was 91.50%(183/200),which was higher than 60.50%(121/200)of the control group,and the difference was statistically significant(χ^(2)=7.259,P<0.05).When the two groups were treated with pantoprazole,the cure rate of the control group was 68.92%(51/74)lower than that of the study group 90.12%(73/81),the difference was statistically significant(χ^(2)=10.867,P<0.05);when the two groups received the same dose of omeprazole proton pump inhibitor,the cure rate of the control group was 55.56%(70

关 键 词：CYP2C19基因多态性 质子泵抑制剂 幽门螺杆菌 精准用药 

分 类 号：R969[医药卫生—药理学]