CYP2C19基因多态性对亚洲人群中含质子泵抑制剂三联疗法幽门螺杆菌根除率影响的荟萃分析

Effect of CYP2C19 Gene Polymorphism on Helicobacter pylori Eradication Rate of Proton Pump Inhibitor-based Triple Therapy in Asian Population:A Meta-analysis

背景:以质子泵抑制剂(PPI)为基础的三联疗法的幽门螺杆菌(H.pylori)根除率不尽相同,可能与细胞色素P450(CYP)2C19基因多态性有部分关联。目的:研究CYP2C19基因多态性对亚洲人群中以PPI为基础的三联疗法H.pylori根除率的影响。方法:在PubMed、EMBASE、CNKI和万方数据中进行系统文献检索,以RevMan4.2.8软件行荟萃分析。结果:共17篇文献纳入荟萃分析。不考虑PPI类型,CYP2C19弱代谢型(PM)与杂合子强代谢型(HetEM)之间、PM与纯合子强代谢型(HomEM)之间、HetEM与HomEM之间H.pylori根除率均有显著差异(PM对HetEM:OR=1.75,95%CI1.24～2.47,P=0.002;PM对HomEM:OR=2.82,95%CI1.73～4.60,P<0.0001;HetEM对HomEM:OR=1.84,95%CI1.33～2.57,P=0.0003)。在以奥美拉唑或兰索拉唑为基础的三联疗法中,PM与HomEM之间、HetEM与HomEM之间H.pylori根除率均有显著差异(含奥美拉唑方案PM对HomEM:OR=4.37,95%CI1.86～10.26,P=0.0007,HetEM对HomEM:OR=3.15,95%CI1.75～5.66,P=0.0001;含兰索拉唑方案PM对HomEM:OR=3.06,95%CI1.56～6.00,P=0.001,HetEM对HomEM:OR=1.95,95%CI1.03～3.70,P=0.04)。在以雷贝拉唑为基础的三联疗法中,PM、HetEM、HomEM三组间H.pylori根除率均无明显差异。结论:在亚洲人群中,以奥美拉唑和兰索拉唑为基础的三联疗法,其H.pylori根除率受CYP2C19基因多态性影响,以雷贝拉唑为基础的三联疗法则否。

It has been noted that the Helicobacter pylori （H. pylori） eradication rate of proton pump inhibitor （PPI）- based triple therapy varies, and this variation may be partially related to the polymorphism of cytochrome P450 （CYP） 2C19 gene. Aims： To investigate the effect of CYP2C19 gene polymorphism on H. pylori eradication rate of PPI-based triple therapy in Asian population. Methods： A systematic literature search was conducted using PubMed, EMBASE, CNKI （Chinese） and Wanfang Data （Chinese） digital database. Meta-analysis was performed with RevMan 4.2.8 software. Results： Seventeen articles were included in this meta-analysis. Overall, H. pylori eradication rates were significantly different between poor metabolizers （PM） and heterozygous extensive metabolizers （HetEM） （OR=1.75, 95% CI 1.24-2.47, P=0.002）, PM and homozygous extensive metabolizers （HomEM） （OR=2.82, 95% CI 1.73-4.60, P〈O.0001）, as well as HetEM and HomEM （OR=1.84, 95% CI 1.33-2.57, P=0.0003）. Omeprazole- or lansoprazole-based triple therapy achieved higher H. pylori eradication rates in PM than in HomEM （OR=4.37, 95% CI 1.86-10.26, P=O.0007 for omeprazole, and OR=3.06, 95% CI 1.56- 6.00, P=0.001 for lansoprazole）, and also higher eradication rates were achieved in HetEM than in HomEM （OR=3.15, 95% CI 1.75-5.66, P=0.0001 for omeprazole, and OR=1.95, 95% CI 1.03-3.70, P=0.04 for lansoprazole）. However, rabeprazole-based triple therapy had similar H. pylori eradication rates among PM, HetEM and HomEM patients. Conclusions： In Asian population, 11. pylori eradication rates of omeprazole-and lansoprazole-based triple therapy are dependent upon CYP2C19 genotypes, whereas the efficacy of rabeprazole-based triple therapy is not affected by CYP2C19 polymorphism.