基因多态性对质子泵抑制剂联合阿莫西林与克拉霉素三联疗法根除幽门螺杆菌效果的影响

目的探讨CYP2C19基因多态性对质子泵抑制剂联合阿莫西林与克拉霉素三联疗法根除幽门螺杆菌（Hp）的影响。方法选择90例Hp阳性的消化性溃疡患者，随机分成观察组与对照组，每组45例，所有患者均于治疗前测定cYP2C19基因型，分为EM、IM及PM型。观察组给予雷贝拉唑＋阿莫西林＋克拉霉素口服，对照组给予奥美拉唑＋阿莫西林＋克拉霉素口服，两组均治疗1周。停药4周后检测Hp根除情况。结果观察组与对照组HP根除率分别为85：7％和77．8％，差异无统计学意义（P〉0．05）；观察组EM、IM、PM型HP根除率及各基因分型比较，差异无统计学意义（P〉0．05）；对照组EM与IM、EM与PM之间HP根除率差异有统计学意义（P〈O．01），IM与PM间差异无统计学意义（P〉0．05）。结论CYP2C19基因多态性对雷贝拉唑联合阿莫西林与克拉霉素三联疗法Hp根除率无明显影响，对奥美拉唑联合阿莫西林与克拉霉素三联疗法的Hp根除率影响较大。

Effect of gene polymorphisms on triple therapy with a proton pump inhibitor,amoxicillin and clarithromycin for eradi-cation of helicobacter pylori

Objective To study the CYP2C19 gene polymorphisms on triple therapy with a proton pump in- hibitor,amoxicillin and clarithromycin for eradication of helicobacter pylori（Hp）. Methods 90 peptic ulcer patients of Hp positive were randomly divided into observation group and control group,45 cases in each group. CYP2C19 geno- type in all patients were measured before treatment, and divided into EM, IM and PM. The patients in observation group were given rabeprazole, amoxicillin and clarithromycin orally, and the patients in control group were given ome- prazole,amoxicillin and clarithromycin orally. The two groups were treated for 1 week. Hp eradication was detected 4 weeks after drug withdrawal. Results The Hp eradication rate in observation group and control group were 85.7~//oo and 77.8~ ,respectively. There was no statistical difference（P~0.05）. The each genotyping of EM,IM and PM Hp eradication rate in observation group had no statistical difference（P~0.05）. The difference of Hp eradication rate be- tween EM and IM,EM and PM in control group were significant（P~0.01）, and there was no significant difference between IM and PM（P~0.05）. Conclusion CYP2C19 gene polymorphisms have no obvious influence on the Hp e- radication rate of triple therapy with rabeprazole,amoxicillin and clarithromycin,but greatly affect the Hp eradication rate of the triple therapy with omeprazole,amoxicillin and clarithromycin.