目的 探讨雷贝拉唑钠肠溶片联合四联疗法治疗不同细胞色素氧化酶P450 2C19（CYP2C19）基因代谢型幽门螺旋杆菌阳性慢性胃炎的临床疗效。方法 选取2015年2月—2018年10月在西安市第一医院消化科住院的240例幽门螺旋杆菌阳性慢性胃炎患者作为研究对象，经基因检测确定了CYP2C19基因型，其中快代谢型（EM）、中等代谢型（IM）、慢代谢型（PM）各80例。每种代谢型患者再随机分为对照组和治疗组，每组各40例。对照组患者均行四联疗法，静脉泵入注射用泮托拉唑钠，40 mg溶于生理盐水50 mL，2次/d；静脉泵入注射用阿莫西林钠克拉维酸钾，1.2 g溶于生理盐水50 mL，2次/d；口服胶体酒石酸铋胶囊220 mg，2次/d；口服克拉霉素片，500 mg/次，2次/d。治疗组在对照组治疗的基础上口服雷贝拉唑钠肠溶片，1片/次，2次/d。两组患者均连续治疗14 d。完全停药1月后行呼气试验检测。观察患者的幽门螺旋杆菌根除率，比较不良反应发生情况。结果 EM型治疗组与对照组根除率比较，差异具有统计学意义（P<0.05）；IM型、PM型治疗组与对照组根除率比较，差异无统计学意义。3个治疗组中，PM型根除率（95.0%）最高，IM型根除率（77.5%）次之，EM型根除率（57.5%）最低，组间根除率比较差异具有统计学意义（P<0.05）。3个对照组中，PM型根除率（97.5%）最高，IM型根除率（92.5%）次之，EM型根除率（82.5%）最低，组间根除率比较差异无统计学意义。结论 以泮托拉唑静点为基础的四联疗法受CYP2C19基因多态性的影响小。但对于快代谢型加用雷贝拉唑钠肠溶片可提高幽门螺旋杆菌根除率，效果较中等代谢型、慢代谢型明显。

Objective To observe the clinical curative effect of Rabeprazole Sodium Enteric-coated Tablets combined with quadruple therapy for different CYP2C19 gene-metabolic Helicobacter pylori-positive chronic gastritis. Methods Patients (240 cases) with Helicobacter pylori-positive chronic gastritis in First Hospital of Xi'an from February 2015 to October 2018 were selected, and was confirmed CYP2C19 genotype by genetic testing. Patients of extensive metabolizer, intermediate metabolizers, and poor metabolizer had 80 cases. Each metabolic patients were divided into control group (40 cases) and treatment group (40 cases). Patients in the control group were treated with quadruple therapy. Patients in the control group were iv administered with Pantoprazole sodium for injection, 40 mg dissolved in 50 mL normal saline, twice daily; also iv administered with Amoxicillin sodium and Clavulanate potassium for injection with 1.2 g dissolved in 50 mL normal saline, twice daily; and po administered with Colloidal Bismuth Tartrate Capsules 220 mg and Clarithromycin Tablets 500 mg/time, twice daily. Patients in the treatment group were po administered with Rabeprazole Sodium Enteric-coated Tablets on the basis of the control group, 1 tablet/time, twice daily. Patients in two groups were treated for 14 d. One month after complete withdrawal, breath test was performed. After treatment, the eradication rate of H. pylori was evaluated, and incidences of adverse reactions were compared. Results After treatment, the eradication rates in the EM-type treatment group was significantly lower than that in the control group, and there were differences between two groups (P<0.05). There was no significant difference of eradication rate between IM-type treatment group and control group. Among the three treatment groups, PM type eradication rate (95.0%) was the highest, IM type eradication rate (77.5%) was the second, and EM type eradication rate (57.5%) was the lowest, and there was significant difference between groups (P<0.05). Among the three control groups, PM type eradication rate (97.5%) was the highest, IM type eradication rate (92.5%) was the second, and EM type eradication rate (82.5%) was the lowest, and there was no significant difference between the two groups. Conclusion The quadruple therapy based on intravenous drip of pantoprazole is less affected by the CYP2C19 gene polymorphism. However, for fast metabolizing type, the combination with Rabeprazole Sodium Enteric-coated Tablets can increase the H. pylori eradication rate, which is more effective than the intermediate metabolite and slow metabolizing types.

陕西省科学技术研究发展计划项目（2016SF-197）