CAJ | 학술논문

目的研究以质子泵抑制剂(PPI)、左氧氟沙星、羟氨苄青霉素作为一线疗法对幽门螺杆菌(Hp)根除的影响,以及Hp根除率与CYP2C19基因多态性的相关性.方法 205例Hp阳性的患者被分为4组:埃索美拉唑20 mg 2次/d(E_(20)组),埃索美拉唑40 mg 2次/d(E_(40)组),雷贝拉唑10 mg 2次/d(R组),兰索拉唑30 mg 2次/d(L组),4组均加左氧氟沙星500 mg 1次/d和羟氨苄青霉素1000 mg 2次/d,疗程1周.其中有161例患者进行了CYP2C19基因型的检测,对Hp根除率分别按意愿治疗(intention-to-treat,ITT)分析和按方案(per protocol,PP)分析进行评估.结果 Hp总根除率为83.4%(PP)和79.0%(ITT).各组的根除率为:E_(20)组86.7%,E_(40)组88.5%,R组73.5%,L组78.1%.其中完成基因型检测的161例患者中,各基因型的根除率分别为:纯合子弱代谢型(PM)90%,杂合子强代谢型(HetEM)81.5%,纯合子强代谢型(HomEM)82.1%.CYP2C19各基因型间Hp根除率、各治疗方案间的根除率及各方案内各基因型间的根除率差异均无统计学意义(P>0.05).结论以PPI为基础包含左氧氟沙星的三联疗法是目前根除Hp的有效方案,且该方案对Hp的根除率不受CYP2C19基因多态性的影响.
목적 연구이질자빙억제제(PPI)、좌양불사성、간안변청매소작위일선요법대유문라간균(Hp)근제적영향,이급Hp근제솔여CYP2C19기인다태성적상관성.방법 205례Hp양성적환자피분위4조:애색미랍서20 mg 2차/d(E_(20)조),애색미랍서40 mg 2차/d(E_(40)조),뢰패랍서10 mg 2차/d(R조),란색랍서30 mg 2차/d(L조),4조균가좌양불사성500 mg 1차/d화간안변청매소1000 mg 2차/d,료정1주.기중유161례환자진행료CYP2C19기인형적검측,대Hp근제솔분별안의원치료(intention-to-treat,ITT)분석화안방안(per protocol,PP)분석진행평고.결과 Hp총근제솔위83.4%(PP)화79.0%(ITT).각조적근제솔위:E_(20)조86.7%,E_(40)조88.5%,R조73.5%,L조78.1%.기중완성기인형검측적161례환자중,각기인형적근제솔분별위:순합자약대사형(PM)90%,잡합자강대사형(HetEM)81.5%,순합자강대사형(HomEM)82.1%.CYP2C19각기인형간Hp근제솔、각치료방안간적근제솔급각방안내각기인형간적근제솔차이균무통계학의의(P>0.05).결론 이PPI위기출포함좌양불사성적삼련요법시목전근제Hp적유효방안,차해방안대Hp적근제솔불수CYP2C19기인다태성적영향.
Objective To assess the efficacy of triple therapy including proton pump inhibitor (PPI), levofloxacin and amoxicillin for the first-line treatment of H. pylori infection, and the relation between H. pylori eradication and CYP2C19 genetic polymorphism. Methods Two hundred and five H. pylori-positive patients were divided into group E_(20) (esomeprazole 20 mg twice daily), group E_(40)(esomeprazote 40 mg twice daily),group R (rabeprazole 10 mg twice daily) and group L (lansoprazole 30 mg twice daily). Besides PPI, all patients were received levofloxacin 500 mg daily and amoxicillin 1000 mg twice daily for 1 week. The CYP2C19 genotypes were detected in 161 patients. The eradication of H. pylori were analyzed by intention-to-treat (ITT) and per protocol (PP) methods.Results The H. pylori eradication was 86.70% in group E_(20), 88.5% in group E_(40),73.5% in group R and 78.1% in group L. Whereas the H. pylori eradication was 90% in patients with PM genotype,81.5% in patients with HetEM genotype and 82.1% in patients with HomEM genotype. The H.pylori eradication was 83.4% and 79.00% by per protocol (PP) and intention-to-treat (ITT) analyses,respectively. There was no significant difference in H. pylori eradication among four groups (P>0.05), and no relation was found between H. pylori eradication and genotypes (P>0.05). Conclusions PPI based triple therapy was effective in eradication of H. pylori, which is not influenced by CYP2C19 genotypes.