雷贝拉唑根除幽门螺杆菌疗效及其与CYP2C19基因多态性的关系

目的 :比较含质子泵抑制剂 (PPI)雷贝拉唑与奥美拉唑的三联疗法根除幽门螺杆菌 (Hp)的疗效与细胞色素P4 5 0 2C19(CYP2C19)基因多态性的关系。方法 :采用随机、对照研究方法 ,将 16 9例经胃镜检查被确诊为慢性胃炎且Hp阳性的连续患者分为两个治疗组 :雷贝拉唑组 (RAC组 )和奥美拉唑组 (OAC组 )。RAC组 :雷贝拉唑 10mg ;OAC组 :奥美拉唑 2 0mg ;两组均联用阿莫西林 10 0 0mg和克拉霉素 5 0 0mg ,疗程 1周。采用PCR RFLP进行CYP2C19基因型分析。结果 :16 0例完成治疗方案。RAC组及OAC组的Hp根除率按PP分析及按ITT分析均未达统计学差异 (P >0 .0 5 )。RAC组中 ,弱代谢型 (PM)、中间代谢型 (IM)及强代谢型 (EM)各基因型间Hp根除率未达统计学差异 (P >0 .0 5 )。OAC组中 ,IM型与EM型间 (P <0 .0 1)及EM型与PM型间 (P <0 .0 5 )差异均有显著性 ,而IM型与PM型间差异未达显著性 (P >0 .0 5 )。结论 :雷贝拉唑与奥美拉唑两组三联疗法均能有效根除Hp ,两组总的疗效差异无显著性。雷贝拉唑三联疗法在根除Hp中疗效较稳定 ,个体间差异小。

Effect of Rabeprazole on Eradication of Helicobacter Pylori and Its Correlation to CYP2C19 Genetic Polymorphisms

Objective:To investigate the efficacy of 1-week triple therapy with amoxicillin, clarithromycin and either rabeprazole or omeprazole in the eradication of Helicobacter pylori(H. pylori) and to investigate whether or not the CYP2C19 genotype affected the eradication rate. Methods: One hundred and sixty-nine patients with chronic H. pylori positive gastritis confirmed by endoscopy and histology were eligible to this study. Patients were randomly assigned to receive one of the two regimens:clarithmycin 500mg bid and amoxicillin 1000 mg bid together with either rabeprazole 10 mg bid or omeprazole 20 mg bid for 1 week course. Their blood CYP2C19 genotyping was detected by PCR-RFLP. Results: One hundred and sixty patients completed the trial.The difference of the eradication rates of H. pylori in RAC group and OAC group did not reach significant on a per protocol analysis and on an intention-to-treat analysis(P>0.05). In RAC group, CYP2C19 genetic polymorphism did not show significant effect on the efficacy in this groups. In OAC group, there were statistically significant differences between EM and IM(P<0.01) or PM(P<0.05), but not between PM and IM(P>0.05). Conclusion: Both RAC and OAC triple therapy eradicated H. pylori effectively. The efficacy of rabeprazole-based triple therapy was less affected by the CYP2C19 genotype.