Meta Analysis Of The Effect Of CYP2C19 Gene Polymorphism On The Eradication Of Helicobacter Pylori By Proton Pump Inhibitors In Chinese

Objective:To systematically evaluate and summarize the effect of CYP2C19 gene polymorphism on the efficacy of proton pump inhibitors in eradicating Helicobacter pylori,so as to provide evidence-based medicine for clinical individualized drug use.Methods:Search by subject words plus free words PubMed,EMBASE,CBM,Coch rne Library,CNKI,Wanfang database,CQVIP journal and other databases wereused to search and collect the CYP2C19 gene polymorphism and the clinical research literat ure on the eradication of Helicobacter pylori infection by proton pump inhibitors,a nd supplement relevant literature through Google academic and other websites.The retrieval time was from September 2019 when the database was established.Accordi ng to the inclusion criteria and exclusion criteria,the literature was selected and eval uated,and the final inclusion criteria were alladopted RevMan5.3 and stata15.1 Met a analysis.Results:31 cases were selected,including 19 cases related to triple therapy,8 c ases related to bismuth containing agent quadruple therapy,3 cases of hybrid therap y and 1 case of sequential therapy.The results of Meta-analysis showed that:regardle ss of the type of proton pump inhibitors,the different eradication programs were ana lyzed.(1)There were significant differences in the eradication rate of Helicobacter pylo ri between CYP2C19 Extensive Metabolizer(EM),Intermediate Metabolizer(IM)and Poor Metabolizer(PM)in triple therapy[EMvsIM:OR=0.65,95%CI(0.53,0.80),P < 0.0001;EMvsPM:OR=0.39,95%CI(0.29,0.53)P<0.00001;IMvsPM:OR=0.55,95%C I(0.40,0.75),P=0.0002].(2)There are differences between EM and PM types inbismut h containing agent quadruple therapy[EMvsPM:OR=0.57,95%CI(0.33,0.98),P=0.04].But there was no difference between EM type and IM type,IM type and PM type.(3)There was no significant difference between the hybrid therapy and sequential the rapy.(4)In the analysis of triple therapy subgroup,three genotypes in the scheme con taining Omeprazole were statistically significant[EMvsIM:OR=0.32,95%CI(0.21,0.48),P<0.00001;EMvsPMl:OR=0.16,95%CI(0.08,0.30),P<0.00001;IMvsPM:OR=0.45,95%CI(0.23,0.89),P=0.02].Esomeprazole is also different in EM type and PM type[EM vsPM:OR=0.30,95%CI(0.12,0.73),P=0.009].This difference also exists in other prot on pump inhibition[EMvsPM:OR=0.48,95%CI(0.27,0.85),P=0.01](5)In the tetrad sche me of bismuth containing agents,Rabeprazole and Pantoprazole are different in EM type and IM type,EM type and PM type[EMvsIM:OR=0.44,95%CI(0.24,0.81),P=0.008;EMvsPM:OR=0.33,95%CI(0.12,0.89),P=0.03].According to the type of proton pump inhibitors,(6)there was no significant difference in the efficacy of Rabeprazol e in eradicating Helicobacter pylori among the different genotypes.[EMvsIM:OR=0.91,95%CI(0.64,1.29),P=0.59;EMvsPM:OR=0.73,95%CI(0.44,1.19),P=0.20;IMvsPM:OR=0.70,95%CI(0.43,1.13),P=0.14].(7)There was no significant difference in the effective rate of Esomeprazole in eradication of Helicobacter pylori among different genome ty pe[EMvsIM:OR=0.74,95%CI(0.55,1.01),P=0.06;EMvsPM:OR=0.74,95%CI(0.48,1.15),P=0.18;IMvsPM:OR=1.07,95%CI(0.69,1.68),P=0.75].(8)However,in subgroup analysis,t he eradication rate of Esomeprazole triple therapy in EM type was significantly lower than that in IM type and PM type[EMvsIM:OR=0.50,95%CI(0.28,0.91),P=0.02;EMvs PM:OR=0.26,95%CI(0.10,0.70),P=0.008].The eradication rate of sequential therapy o r hybrid therapy with Esomeprazole in IMgroup was significantly lower than that in PM group[IMvs PM:OR3.38,95%(1.35,8.460),P=0.009].(9)Pantoprazole has no stati stical difference among genomes in different eradication programs.[EMvsIM:OR=0.80,95%CI(0.50,1.29),P=0.37;EMvsPM:OR=0.51,95%CI(0.26,1.02),P=0.06;IMvsPM:O R=0.63,95%CI(0.32,1.26),P=0.19].Conclusion:The effect of CYP2C19 gene polymorphism on different PPIs is different.PPIs is the main drug for eradicating Helicobacter pylori.CYP2C19 ge ne polymorphism also plays a role in the effective rate of eradicating Helicobact er pylori to some extent.It can improve the eradication rate of Helicobacter pyl ori to provide individualized treatment according to the genotype of patients.