难治性胃食管反流病脾虚证CYP2C19基因表达及中药干预研究

CYP2C19 Gene Expression of Refractory Gastroesophageal Reflux Disease Patients with Pi Deficiency Syndrome and Intervention of Chinese Herbs

目的探讨难治性胃食管反流病(RGERD)脾虚证CYP2C19基因表达情况及中药干预疗效,观察不同代谢型患者使用质子泵抑制剂(PPI)联合补中益气颗粒治疗效果。方法对82例RGERD脾虚证患者行PCR-RFLP进行基因分型,分为强代谢型组68例和弱代谢型组14例。两组患者在服用PPI基础上,加用补中益气颗粒4周,观察两组患者反流性疾病问卷表(RDQ量表)症状评分和总分及脾虚症状患者变化情况。结果强代谢型组患者治疗后反流、烧心、非心源性胸痛评分及RDQ总分较治疗前显著下降(P<0.05),其口淡、食少纳呆、神疲乏力、便溏患者例数也显著减少(P<0.05)。弱代谢型组患者治疗后反酸、反流、烧心、非心源性胸痛评分及RDQ总分虽下降,但差异无统计学意义(P>0.05),其食少纳呆、神疲乏力、便溏患者例数较治疗前显著减少(P<0.05)。结论 RGERD脾虚证药物干预效果与其CYP2C19基因表达相关,PPI联合中药治疗RGERD对CYP2C19基因强代谢型疗效更为显著。

Objective To observe the expression of CYP2C19 gene and the intervention of Chi- nese herbs （CHs） on refractory gastroesophageal reflux disease （RGERD） patients with Pi deficiency syndrome （PDS）, and to observe the effect of proton pump inhibitor combined with Buzhong Yiqi Granule （BYG） on them with different metabolic types. Methods Totally 82 RGERD patients with PDS were geno- typed by PCR-RFLP and assigned to strong metabolism group （68 cases） and weak metabolism group （14 cases）. On the basis of PPI, all patients additionally took BYG for 4 successive weeks. Finally, the symptom score and total score of the RDQ scale （reflux disease questionnaire） and the symptoms of PDS were observed in the two groups. Results The scores of reflux, heartburn, noncardiogenic chest pain, and total score of the RDQ scale were significantly decreased after treatment in strong metabolism group （P 〈0.05）. Besides, tastelessness, poor appetite, tiredness, and loose stool occurred significantly in less patients of strong metabolism group （P 〈0.05）. In weak metabolism group scores of acid regur- gitation, reflux, heartburn, noncardiogenic chest pain, and total score of the RDQ were decreased after treatment （P 〉0.05）. In addition, poor appetite, tiredness, and loose stool occurred significantly in less patients of week metabolism group （P 〈0.05）. Conclusions The effect of drug intervention on RGERD patients with PDS was related to the expression of CYP2C19 gene. PPI combined with CHs for treatment of RGERD had more significantly effect on strong metabolic type of CYP2C19 gene.