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目的:采用Meta分析方法评价中国人群中药物代谢酶CYP2C19基因多态性与质子泵抑制药对消化性溃疡愈合率的关系,以期为临床用药与基因检测提供循证依据。方法:检索Sino Med、中国知网、维普期刊数据库、万方数据库、PubMed、Embase中有关CYP2C19基因多态性与质子泵抑制药治疗消化性溃疡的临床研究文献。根据纳入和排除标准筛选文献、评价和提取数据后,采用RevMan 5.3与Stata 13.0软件进行Meta分析。结果:共纳入8篇文献,包含1 197例对象。Meta分析结果显示:不考虑质子泵抑制药类型,CYP2C19强代谢型(EM)的消化性溃疡愈合率低于与中间代谢型(IM)(OR=0.63,95%CI:0.46~0.86,P<0.05),EM型的消化性溃疡愈合率低于与弱代谢型(PM)(OR=0.45,95%CI:0.29~0.69,P<0.05),但IM型与PM型消化性溃疡愈合率的差异无统计学意义(OR=0.68,95%CI:0.44~1.04,P>0.05)。亚组分析仅发现同样结果存在于奥美拉唑中,EM型消化性溃疡愈合率低于IM型低(OR=0.59,95%CI:0.36~0.97,P<0.05),EM型消化性溃疡愈合率亦低于PM型(OR=0.29,95%CI:0.13~0.62,P<0.05),但IM型与PM型的差异无统计学意义(P>0.05)。其他质子泵抑制药如雷贝拉唑、埃索美拉唑、艾普拉唑等未发现上述差异。结论:中国人群中CYP2C19基因多态性影响奥美拉唑的消化性溃疡愈合率疗效,但不影响埃索美拉唑、雷贝拉唑、艾普拉唑等其他质子泵抑制药的疗效。因此,在应用奥美拉唑治疗消化性溃疡时,有必要对患者的CYP2C19进行基因检测,以指导个体化给药方案的制订。
OBJECTIVE: To evaluate the relationship between CYP2C19 polymorphism and proton pump inhibitor on the healing rate of peptic ulcer in Chinese population by Meta-analysis, and to provide evidence-based evidence for clinical use and genetic testing. Methods: Clinical studies on CYP2C19 gene polymorphisms and proton pump inhibitors in the treatment of peptic ulcer were searched in Sino Med, China National Knowledge Infrastructure, VIP Journal Database, Wanfang Database, PubMed and Embase. After scoring the literature according to inclusion and exclusion criteria, evaluating and extracting data, Meta-analysis was performed using RevMan 5.3 and Stata 13.0 software. Results: A total of 8 articles were included, including 1 197 subjects. The results of Meta analysis showed that the healing rate of peptic ulcer of CYP2C19 strongly metabolized (EM) was lower than that of intermediate metabotropic (IM), regardless of the type of proton pump inhibitor (OR = 0.63,95% CI: 0.46-0.86, P < 0.05). The healing rate of peptic ulcer with EM type was lower than that with weak metabolic type (OR = 0.45, 95% CI: 0.29-0.69, P <0.05) The difference was not statistically significant (OR = 0.68, 95% CI: 0.44 ~ 1.04, P> 0.05). In subgroup analysis, the same result was found only in omeprazole. The healing rate of EM peptic ulcer was lower than that of IM type (OR = 0.59, 95% CI: 0.36-0.97, P <0.05) The healing rate was also lower than that of PM type (OR = 0.29, 95% CI: 0.13-0.62, P <0.05), but there was no significant difference between IM type and PM type (P> 0.05). Other proton pump inhibitors such as rabeprazole, esomeprazole, ilaprazole did not find the above differences. CONCLUSIONS: CYP2C19 polymorphism in Chinese population affects the efficacy of omeprazole in the healing rate of peptic ulcer, but does not affect the efficacy of other proton pump inhibitors such as esomeprazole, rabeprazole and ilaprazole. Therefore, in the application of omeprazole treatment of peptic ulcer, it is necessary to conduct genetic testing of patients with CYP2C19 to guide the development of individualized dosing regimen.