MDR1基因C3435T多态性对兰索拉唑、阿莫西林和克拉霉素三联疗法治疗幽门螺杆菌感染治愈率的影响，与幽门螺杆菌的CYP 2C19基因型和23S rRNA基因型的关系
Effect of MDR1 C3435T polymorphism on cure rates of Helicobacter pylori infection by triple therapy with lansoprazole, amoxicillin and clarithromycin in relation to CYP 2C19 genotypes and 23S rRNA genotypes of H. pylori.
作者信息
Furuta T, Sugimoto M, Shirai N, Matsushita F, Nakajima H, Kumagai J, Senoo K, Kodaira C, Nishino M, Yamade M, Ikuma M, Watanabe H, Umemura K, Ishizaki T, Hishida A
机构信息
Center for Clinical Research, Hamamatsu University School of Medicine, Hamamatsu, Japan.
出版信息
Aliment Pharmacol Ther. 2007 Sep 1;26(5):693-703. doi: 10.1111/j.1365-2036.2007.03408.x.
BACKGROUND
Polymorphism in MDR1 is associated with variation in the plasma level of a proton pump inhibitor.
AIM
To investigate whether MDR1 polymorphism is associated with eradication rates of Helicobacter pylori by a triple therapy with lansoprazole, amoxicillin and clarithromycin in relation to CYP2C19 genotype status and bacterial susceptibility to clarithromycin.
METHODS
A total of 313 patients infected with H. pylori completed the treatment with lansoprazole 30 mg b.d., clarithromycin 200 mg b.d. and amoxicillin 750 mg b.d. for 1 week. MDR1 C3435T polymorphism and CYP2C19 genotypes of patients and sensitivity of H. pylori to clarithromycin were determined.
RESULTS
Logistic regression analysis revealed that the MDR1 polymorphism as well as CYP2C19 genotypes of patients and clarithromycin-resistance of H. pylori were significantly associated with successful eradication. Eradication rates for H. pylori were 82% (83/101: 95% CI = 73-89), 81% (112/139: CI = 73-87), and 67% (44/73: CI = 48-72) in patients with the MDR1 3435 C/C, C/T and T/T genotype, respectively (P = 0.001).
CONCLUSIONS
Polymorphism of MDR1 is one of the determinants of successful eradication of H. pylori by the triple therapy with lansoprazole, amoxicillin and clarithromycin, together with CYP2C19 genotype and bacterial susceptibility to clarithromycin.
背景
多药耐药基因1（MDR1）的多态性与质子泵抑制剂血浆水平的变化有关。
目的
研究MDR1多态性与采用兰索拉唑、阿莫西林和克拉霉素三联疗法根除幽门螺杆菌的根除率之间的关系，同时探讨其与细胞色素P450 2C19（CYP2C19）基因型状态以及细菌对克拉霉素敏感性的关系。
方法
总共313例幽门螺杆菌感染患者完成了为期1周的治疗，治疗方案为每日2次口服30 mg兰索拉唑、每日2次口服200 mg克拉霉素和每日2次口服750 mg阿莫西林。测定患者的MDR1 C3435T多态性、CYP2C19基因型以及幽门螺杆菌对克拉霉素的敏感性。
结果
逻辑回归分析显示，患者的MDR1多态性、CYP2C19基因型以及幽门螺杆菌对克拉霉素的耐药性与根除成功显著相关。MDR1 3435 C/C、C/T和T/T基因型患者的幽门螺杆菌根除率分别为82%（83/101：95%可信区间[CI]=73 - 89）、81%（112/139：CI = 73 - 87）和67%（44/73：CI = 48 - 72）（P = 0.001）。
结论
MDR1多态性是采用兰索拉唑、阿莫西林和克拉霉素三联疗法成功根除幽门螺杆菌的决定因素之一，同时还与CYP2C19基因型以及细菌对克拉霉素的敏感性有关。
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