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目的:分析CYP2C19基因多态性对三联疗法治疗幽门螺旋杆菌(Helicobacter pylori,Hp)治愈率的影响。方法:研究对象为280例幽门螺旋杆菌感染的患者,随机分为2组。一组(OAC组)使用奥美拉唑+阿莫西林+甲硝唑,持续使用2周,另一组(PAC组)使用泮托拉唑+阿莫西林+甲硝唑。通过聚合酶链式反应+限制片段长度多态性分析患者CYP2C19基因型,包括:野生型和两种突变型(*2,外显子5突变;*3,外显子4突变)。观察基因型对药物疗效的影响。结果:在OAC组中,强代谢型(homEM型)的治愈率为73.2%,中间代谢型(hetEM型)为77.4%,而弱代谢型(PM型)为83.8%,不同CYP2C19基因型之间的治愈率有显著性差异(P<0.05)。PAC组中,强代谢型的治愈率为80.0%,中间代谢型为81.0%,而弱代谢型为86.5%,不同CYP2C19基因型之间治愈率无显著性差异(P>0.05)。结论:泮托拉唑与奥美拉唑2种三联疗法均能有效根除Hp,总疗效差异无统计学意义。但泮托拉唑三联疗法疗效较稳定,不受CYP2C19基因型影响。
Objective: To analyze the influence of CYP2C19 gene polymorphism on the cure rate of Helicobacter pylori (Hp) by triple therapy. Methods: The subjects were 280 patients with H. pylori infection, were randomly divided into two groups. One group (OAC group) received omeprazole plus amoxicillin plus metronidazole for 2 weeks and the other group (PAC group) received pantoprazole plus amoxicillin plus metronidazole. CYP2C19 genotypes were analyzed by polymerase chain reaction + restriction fragment length polymorphism, including: wild-type and two mutant (* 2, exon 5 mutations; * 3, exon 4 mutations). Observe the effect of genotype on drug efficacy. Results: In the OAC group, the cure rate of the homome type was 73.2%, that of the intermediate type (hetEM type) was 77.4%, and that of the weakly metabolized type (PM type) was 83.8%. Among the different CYP2C19 genotypes The cure rate was significantly different (P <0.05). In the PAC group, the cure rate of strong metabolic type was 80.0%, the intermediate metabolic type was 81.0%, and the weak metabolic type was 86.5%. There was no significant difference between different genotypes of CYP2C19 (P> 0.05). Conclusion: Both pantoprazole and omeprazole triple therapy can effectively eradicate Hp, the total effect was no significant difference. But pantoprazole triple therapy more stable, independent of CYP2C19 genotype.