细胞色素P4502C19基因多态性对以质子泵抑制剂为基础的三联疗法根除幽门螺杆菌疗效的影响

Impact of CYP2C19 genetic polymorphism on efficacy of Helicobacter pylori eradication with proton pump inhibitor-based triple therapy

目的研究以质子泵抑制剂（PPI）、左氧氟沙星、羟氨苄青霉素作为一线疗法对幽门螺杆菌（Hp）根除的影响，以及Hp根除率与CYP2C19基因多态性的相关性。方法205例Hp阳性的患者被分为4组：埃索美拉唑20mg2次／d（E20组），埃索美拉唑40mg2次／d（E40组），雷贝拉唑10mg2次／d（R组），兰索拉唑30mg2次／d（L组），4组均加左氧氟沙星500mg1次／d和羟氨苄青霉素1000mg2次／d，疗程1周。其中有161例患者进行了CYP2C19基因型的检测，对Hp根除率分别按意愿治疗（intention-to—treat，ITT）分析和按方案（perprotocol，PP）分析进行评估。结果Hp总根除率为83．4％（PP）和79．0％（ITT）。各组的根除率为：E2。组86．7％，E40组88．5％，R组73．5％，L组78．1％。其中完成基因型检测的161例患者中，各基因型的根除率分别为：纯合子弱代谢型（PM）90％，杂合子强代谢型（HetEM）81．5％，纯合子强代谢型（HomEM）82．1％。CYP2C19各基因型间Hp根除率、各治疗方案间的根除率及各方案内各基因型间的根除率差异均无统计学意义（P〉0．05）。结论以PPI为基础包含左氧氟沙星的三联疗法是目前根除Hp的有效方案，且该方案对Hp的根除率不受CYP2C19基因多态性的影响。

Objective To assess the efficacy of triple therapy including proton pump inhibitor （PPI）, levofloxacin and amoxicillin for the first line treatment of H. pylori infection, and the relation between H. pylori eradication and CYP2C19 genetic polymorphism. Methods Two hundred and five H. pylori-positive patients were divided into group E20 （esomeprazole 20 mg twice daily）, group E40 （esomeprazole 40 mg twice daily）,group R （rabeprazole 10 mg twice daily） and group L （lansoprazole 30 mg twice daily）. Besides PPI, all. patients were received levofloxacin 500 mg daily and amoxicillin 1000 mg twice daily for 1 week. The CYP2C19 genotypes were detected in 161 patients. The eradication of H. pylori were analyzed by intention-to-treat （ITT） and per protocol （PP） methods. Results The H. pylori eradication was 86.7% in group E20, 88.5% in group E40,73.5%in group R and 78. 1% in group L. Whereas the H. pylori eradication was 90% in patients with PM genotype, 81.5% in patients with HetEM genotype and 82. 1% in patients with HomEM genotype. The H. pylori eradication was 83.4% and 79.0% by per protocol （PP） and intention-to-treat （ITT） analyses,respectively. There was no significant difference in H. pylori eradication among four groups （P〉0. 05）, and no relation was found between H. pylori eradication and genotypes （P〉0.05）. Conclusions PPI based triple therapy was effective in eradication of H. pylori, which is not influenced by CYP2C19 genotypes.