CYP2C9基因与非甾体类抗炎药消化道损伤的Meta分析

Influence of CYP2C9 polymorphisms on gastrointestinal injury associated with nonsteroidal anti-inflammatory drugs: a Meta analysis

目的明确CYP2C9基因多态性与非甾体类抗炎药(NSAIDs)导致消化道损伤的关系。方法计算机检索Pubmed、Embase、Cochrane Library、万方、维普、CNKI、中国生物医学文献数据库至2016年2月1日。纳入评价CYP2C9基因突变与服用NSAIDs相关消化道损伤关系的研究。使用Rev Man 5.2软件计算比值比(OR)及95%可信区间(95%CI),检验异质性并寻找异质性来源。对不能合并分析的研究进行描述性分析。结果共纳入6篇研究,包含5篇病例对照研究,1篇队列研究。5篇病例对照研究的合并分析显示,与对照组相比,携带CYP2C9*2等位基因的NSAIDs服用者消化道损伤风险增加了46%[OR=1.46,95%CI(1.02,2.09)],消化道出血风险增加了59%[OR=1.59,95%CI(1.08,2.33)]。但纳入的原始研究数量不多,基因突变频率低,研究间存在异质性。结论携带CYP2C9*2等位基因可能增加NSAIDs导致消化道损伤风险,但该结果存在局限性,需谨慎对待。

Objective To evaluate whether CYP2C9 variation increased the risk of gastrointestinal injury due to nonsteroidal anti-inflammatory drugs(NSAIDs) use. Methods A fully recursive literature search to February 1st, 2016 was conducted in Pub Med, Embase, Cochrane Library, Wanfang Data, VIP Periodical, CNKI, CBM databases to identify potentially relevant case-control and cohort studies. Studies reporting the frequency of CYP2C9 genetic variants in patients with or without gastrointestinal injury after NSAIDs use were combined to conduct a Meta analysis. Odds ratios(OR) and 95% confidence interval(95% CI) were calculated by Rev Man 5.2 software. We also calculated and looked for heterogeneity. Studies were systematically reviewed when data were not suitable for pooling. Results Six studies(5 case-control and 1 cohort) with a total of 1 392 patients were identified. The pooled data of 5 case-control studies revealed that, with the presence of CYP2C9*2 coding variant, the risk of gastrointestinal injury was increased by 46% [OR=1.46, 95% CI(1.02, 2.09)], and the risk of gastrointestinal bleeding was increased by 59% [OR=1.59, 95% CI(1.08, 2.33)]. Conclusions CYP2C9*2 coding variant might increase the risk of gastrointestinal injury associated with NSAIDs. Our findings warrant further studies to identify their association.