CYP2C19基因多态性对含左氧氟沙星方案根除幽门螺杆菌疗效影响的Meta分析

Meta-analysis of Influence of CYP2C19 Genetic Polymorphisms on Levofloxacin-containing Therapy for Eradication Rates of Helicobacter pylori Infection

目的:系统评价药物代谢酶CYP2C19基因多态性与含左氧氟沙星方案的幽门螺杆菌(HP)感染根除率的关系,以期为选择含左氧氟沙星方案前是否需要检测CYP2C19基因多态性提供依据。方法:检索PubMed、Embase、CBM、CNKI、Wanfang Data、CQVIP等数据库,收集CYP2C19基因多态性与含左氧氟沙星方案根除HP感染的临床研究。根据纳入和排除标准筛选及评价文献、提取数据后,采用Rev Man 5.3和Stata 13.1软件进行Meta分析。结果:共纳入7篇文献,包含846例对象。Meta分析结果显示:CYP2C19强代谢型(EM)或中间代谢型(IM)与弱代谢型(PM)间含左氧氟沙星三联方案(质子泵抑制剂联合阿莫西林与左氧氟沙星)的HP根除率有统计学差异[EM vs PM:78.4%vs 91.7%,OR=0.38,95%CI(0.18,0.79);IM vs PM:83.7%vs91.7%,OR=0.43,95%CI(0.20,0.92),P<0.05]。进一步分析提示可能是质子泵抑制剂奥美拉唑造成上述差异。但EM、IM与PM间含左氧氟沙星铋剂四联方案的HP根除率都无统计学差异(P>0.05)。结论:CYP2C19基因多态性可能影响奥美拉唑联合阿莫西林及左氧氟沙星三联方案HP感染根除效果,但不影响含左氧氟沙星的铋剂四联方案的根除疗效,提示选择含左氧氟沙星的铋剂四联疗法作为根除方案,似乎并不需要检测CYP2C19基因多态性。

Objective:To systematically review the influence of CYP2C19genetic polymorphisms on levofloxacin-containing therapy on eradication rates of Helicobacter pylori(HP)infection.Methods:Such databases as PubMed,Embase,CBM,CNKI,Wanfang Data and CQVIP were electronically searched for clinical studies on CYP2C19genetic polymorphisms and levofloxacinand Helicobacter pylori.According to the inclusion and exclusion criteria,literatures were screened,and data were extracted,and the methodologically quality of included studies were also examined.Meta-analysis were then performed using RevMan5.3and Stata13.1softwares.Results:A total of7studies involving846subjects were included.The results of Meta-analysis showed that CYP2C19genotype status influences levofloxacin-containing triple therapy(proton pump inhibitors and amoxicillin and levofloxacin):eradication rates for Helicobacter pylori in extensive metabolizer(EM)and intermediate metabolizer(IM)phenotypes were slightly lower than in poor metabolizer(PM)phenotype[EM vs PM:78.4%vs91.7%,OR=0.38,95%CI(0.18,0.79);IM vs PM:83.7%vs91.7%,OR=0.43,95%CI(0.20,0.92),P<0.05],respectively.Further analysis demonstrated omeprazole may cause the difference above.CYP2C19genetic polymorphism did not influencetotal eradication rates of Helicobacter pylori in the regiment of levofloxacin-containing bismuth quadruple therapy(P>0.05).Conclusion:CYP2C19genetic polymorphism might affect the efficacy of omeprazole,amoxicillin and levofloxacin triple therapy but did not affect levofloxacin-containing bismuth quadruple therapy to the eradication rates of Helicobacter pylori infection,therefore CYP2C19genetic polymorphism tests were not required if levofloxacin-containing bismuth quadruple therapy was chosen as eradication treatment.