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目的比较雷贝拉唑与奥美拉唑三联疗法根除幽门螺杆菌(Hp)的疗效与细胞色素氧化酶P450 2C19(CYP 2C19)基因多态性的关系。方法采用随机、对照研究方法,将169例因消化不良症状接受常规胃镜检查确诊为慢性胃炎且Hp阳性的连续患者分入两组:雷贝拉唑三联疗法组(RAC组85例)和奥美拉唑三联疗法组(OAC组84例)。Hp诊断依靠组织病理学检查并参考快速尿素酶试验、血清Hp抗体检测结果。RAC组、OAC组均给予三联治疗:RAC组:雷贝拉唑10mg,OAC组:奥美拉唑20mg,两组均联用羟氨苄青霉素1000mg和克拉霉素500mg,全部药物每日2次,疗程7d。采用聚合酶链式反应结合限制性内切酶技术(PCR-RFLP),进行CYP 2C19基因型分析,治疗结束后第28天用14C尿素呼气实验检测Hp根除疗效。结果160例完成治疗方案,RAC组及OAC组的Hp根除率按PP分析及ITT分析均无统计学差异(P>0.05)。根据CYP2C19基因型分析,160例中,弱代谢型(PM)、中间代谢型(IM)及强代谢型(EM)的Hp根除率分别为95.5%(21/22)、85.9%(73/85)和67.9%(36/53),PM型及IM型的Hp根除率均显著高于EM型(P<0.05),而PM型与IM型间差异无统计学意义(P>0.05)。RAC组中,各基因型的Hp根除率差异无统计学意义(P>0.05)。OAC组中,IM型与EM型间(P<0.01)及EM型与PM型间(P<0.05)差异均有统计学意义。结论雷贝拉唑与奥美拉唑两种三联疗法均能有效根除Hp,总疗效差异无统计学意义。雷贝拉唑三联疗法疗效较稳定,个体间差异小。PM型及IM型的Hp根除率均较EM型为高。
Objective To compare the efficacy of rabeprazole and omeprazole triple therapy in the eradication of Helicobacter pylori (Hp) and the relationship between the cytochrome oxidase P450 2C19 (CYP 2C19) gene polymorphism. Methods A randomized controlled study was conducted in 169 consecutive consecutive patients with chronic gastritis and Hp positive diagnosed as dyspeptic symptoms due to dyspepsia by gastroscopy. The rabeprazole triple therapy group (85 cases in RAC group) and Ogilvy & Mather The three groups of clozapine (OAC group, 84 cases). Hp diagnosis depends on histopathological examination and reference to rapid urease test, serum Hp antibody test results. RAC group, OAC group were given triple therapy: RAC group: rabeprazole 10mg, OAC group: omeprazole 20mg, two groups were combined with amoxicillin 1000mg and clarithromycin 500mg, all the drug 2 times a day, Treatment 7d. CYP2C19 genotypes were analyzed by polymerase chain reaction and restriction endonuclease technique (PCR-RFLP). Hp eradication efficacy was measured by 14C urea breath test on the 28th day after treatment. Results 160 patients completed the treatment regimen. There was no significant difference in Hp eradication rates between RAC and OAC groups by PP analysis and ITT analysis (P> 0.05). According to the analysis of CYP2C19 genotypes, the Hp eradication rates of mild metabolites (PM), intermediate metabolites (IM) and strong metabolites (EM) were 95.5% (21/22) and 85.9% (73/85 ) And 67.9% (36/53) respectively. The Hp eradication rates of PM type and IM type were significantly higher than those of EM type (P <0.05). There was no significant difference between PM type and IM type (P> 0.05). In RAC group, there was no significant difference in Hp eradication rates among different genotypes (P> 0.05). In the OAC group, there was significant difference between IM type and EM type (P <0.01) and between EM type and PM type (P <0.05). Conclusions Both triple therapy of rabeprazole and omeprazole can effectively eradicate Hp, and the total curative effect has no statistical significance. Rabeprazole triple therapy more stable, small differences between individuals. Hp eradication rates of PM type and IM type are higher than those of EM type.