四川省西南地区汉族人群CYP2C19基因多态性对PPIs治疗幽门螺杆菌疗效的影响

Effect of CYP2C19 gene polymorphism on the efficacy of PPIs in the treatment of Helicobacter pylori in population of Han nationality of southwest Sichuan province

目的探索四川省西南地区汉族人群CYP2C19的基因分布,以及基因多态性对质子泵抑制剂(PPIs)治疗幽门螺旋杆菌疗效的影响。方法收集四川省西南地区住院治疗的162例幽门螺旋杆菌阳性汉族人群患者血样,采用数字荧光杂交测定CYP2C19的基因型,根据结果分为4种代谢类型:超快代谢型(UM)、快代谢型(EM)、中间代谢性(IM)以及慢代谢型(PM),统计不同基因型、代谢型分布频率。PPIs标准剂量下,比较不同代谢型患者幽门螺旋杆菌根除率。快代谢组患者,比较PPIs常标准剂量组和高剂量组的根除率。结果UM型、EM型、IM型以及PM型代谢组分布频率分别为1.85%,42.59%,35.18%,20.37%拉唑标准剂量下,UM、EM组根除率显著低于IM、PM组;艾普拉唑标准剂量下,则无显著影响。根除治疗后患者C-反应蛋白(CRP)与白介素-10(IL-10)含量分别低于治疗前(P<0.05),CRP、IL-10与Hp阳性有关。结论剂量相同的条件下,UM、EM组的根除率更低,但增加剂量可以提高UM、EM组的根除率,这可用于指导临床个体化用药。通过基因检测,可以选择更合适的PPIs剂量。

Objective To explore the gene distribution of CYP2C19 in Han population of southwest Sichuan province as well as the effect of gene polymorphism on the efficacy of proton pump inhibitors(PPIs)in the treatment of Helicobacter pylori.Methods Blood samples were collected from 162 hospitalized Han patients with positive H.pylori in the southwest of Sichuan province.The genotypes of CYP2C19 were detected by digital fluorescence hybridization.According to the results,they were divide into four metabolic types:ultrarapid metabolizer(UM),extensive metabolizer(EM),intermediate metabolizer(IM)and poor metabolizer(PM).The distribution frequency of different genotypes and metabolites was calculated.The eradication rates of H.pylori in patients of different metabolic types were compared under the standard dose of PPIs.For the patients with extensive metabolism,their eradication rates of H.pylori were compared between the normal-dose PPIs group and the high-dose PPIs group.Results The distribution frequencies of UM,EM,IM and PM were 1.85%,42.59%,35.18%and 20.37%,respectively.Under the normal dosage of omeprazole,the eradication rates of H.pylori in the UM and EM groups were significantly lower than those in the IM and PM groups.Under the normal dosage of ilaprazole,there were no significant differences.After the treatment for eradication of H.plyori,the levels of C-reactive protein(CRP)and interleukin-10(IL-10)of the patients were lower than those before treatment(P<0.05).CRP and IL-10 were correlated with positive H.plyori.Conclusion Under the same dose of PPIs,the eradication rates of the UM and EM groups are lower.However,a higher dose of PPIs improves the eradication rates of the UM and EM groups,which could be used to guide clinical individualized drug use.An appropriate dose of PPIs can be selected through genetic testing.