Division of Hepatology and Gastroenterology, Department of Internal Medicine, Lin Shin Hospital, Taichung, Central Taiwan University of Science and Technology, Taipei, Taiwan, ROC.
J Chin Med Assoc. 2010 Apr;73(4):188-93. doi: 10.1016/S1726-4901(10)70039-3.
To investigate whether or not CYP2C19 genotype status is associated with cure rate for Helicobacter pylori infection in patients with cirrhosis and peptic ulcer, achieved with 2 weeks of triple therapy with rabeprazole, amoxicillin and clarithromycin.
We prospectively studied 95 consecutive patients with cirrhosis and H. pylori-infected active peptic ulcers. H. pylori infection was confirmed if any 2 of the following were positive: H. pylori DNA, histology, and rapid urease test. Patients were assigned to an open-label 2-week course of oral amoxicillin 1,000 mg b.i.d., rabeprazole 20 mg b.i.d. and clarithromycin 500 mg b.i.d. Subsequently, all patients received oral rabeprazole 20 mg once daily until week 8. Three months and 1 year after therapy, all patients with cirrhosis were followed up endoscopically for peptic ulcer, rapid urease test, and (13)C-urea breath test. The CYP2C19 genotype status for 2 mutations associated with the extensive metabolizer phenotype was determined by polymerase chain reaction and restriction fragment length polymorphism analysis.
Cure rates for H. pylori infection were 80.9% (95% CI, 22.8-88.6%), 89.8% (95% CI, 50.8-90.2%), and 100% (95% CI, 62.8-100%) in the rapid-, intermediate-, and poor-metabolizer groups, respectively. Healing rates for duodenal and gastric ulcer in the 3 groups were roughly parallel with cure rates for H. pylori infection.
The results of the genotyping test for CYP2C19 seem to predict cure of H. pylori infection and peptic ulcer in patients with cirrhosis who receive triple therapy with rabeprazole, amoxicillin, and clarithromycin.
研究 CYP2C19 基因型是否与肝硬化和消化性溃疡患者接受雷贝拉唑、阿莫西林和克拉霉素三联治疗 2 周后的幽门螺杆菌（H. pylori）感染治愈率相关。
我们前瞻性研究了 95 例连续的肝硬化合并 H. pylori 感染性活动期消化性溃疡患者。如果以下 2 项阳性则可确诊 H. pylori 感染：H. pylori DNA、组织学和快速尿素酶试验。患者接受雷贝拉唑 20 mg 每日 2 次、阿莫西林 1000 mg 每日 2 次和克拉霉素 500 mg 每日 2 次的口服 2 周开放性三联治疗。随后，所有患者接受雷贝拉唑 20 mg 每日 1 次口服，直至第 8 周。治疗后 3 个月和 1 年，所有肝硬化患者均接受内镜检查以评估消化性溃疡、快速尿素酶试验和（13）C-尿素呼气试验。通过聚合酶链反应和限制性片段长度多态性分析，检测与广泛代谢表型相关的 2 个突变的 CYP2C19 基因型。
H. pylori 感染的治愈率分别为 80.9%（95%CI，22.8%-88.6%）、89.8%（95%CI，50.8%-90.2%）和 100%（95%CI，62.8%-100%），在快速代谢、中间代谢和慢代谢组中。3 组的十二指肠和胃溃疡愈合率与 H. pylori 感染的治愈率大致平行。
CYP2C19 基因分型检测结果似乎可预测接受雷贝拉唑、阿莫西林和克拉霉素三联治疗的肝硬化患者 H. pylori 感染和消化性溃疡的治愈。
