Relationship between polymorphism of CYP2C19*2 genotype and cyclophosphamide treatment in systemic lupus erythematosus
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摘要: 目的 研究中国汉族人群中,CYP2C19*2单核苷酸多态性的分布,和对环磷酰胺治疗系统性红斑狼疮的不良反应的影响,为系统性红斑狼疮(systemic lupus erythematosus,SLE)治疗策略的选择提供理论根据。 方法 采用病例-对照研究,收集2007年10月-2013年5月期间在北京协和医院就诊的324名SLE患者和相匹配的非自身免疫性疾病的319名健康志愿者,体检对照,利用多聚酶链式反应、限制性片段长度多态性以及DNA测序验证等技术检测CYP2C19*2基因型。进一步结合临床资料进行统计分析。 结果 在中国人群中,CYP2C19*2突变型的分布频率约为29.9%。SLE患者组内共有237人曾使用环磷酰胺治疗,共163人使用环磷酰胺治疗超过6个月。CYP2C19*2这一突变携带者出现白细胞减少的比例较低,但未发现两者显著相关。而CYP2C19*2基因多态性与是否出现肝功异常、是否出现异常子宫出血均显著相关。多元Logistic回归模型分析CYP2C19*2基因多态性、患者年龄、环磷酰胺累计用量与是否出现异常子宫出血发现,A等位基因和累计剂量均为是否出现异常子宫出血的独立影响因素(P值分别为0.002和<0.001)。 结论 CYP2C19*2突变型在中国汉族人群中较为常见,可能会降低临床应用时部分毒性作用的发生。Abstract: Objective To study the frequency of CYP2 C19*2 polymorphism in Chinese people and the potential effects on adverse reactions during cyclophosphamide treatment in systemic lupus erythematosus (SLE). Methods We studied 324 unrelated Chinese systemic lupus erythematosus patients from Peking Union Medical College Hospital and 319 healthy controls. CYP2 C19*2 polymorphism was genotyped by polymerase chain reaction (PCR) and restriction fragment length polymorphism (RFLP), and then verified by sequencing. Further statistical analysis was carried out with clinical data. Results The observed frequency of mutant CYP2 C19*2 polymorphism is 29.9% in Chinese people. A total of 237 patients in the SLE group had been treated with cyclophosphamide, and 163 patients had been treated with cyclophosphamide for more than 6 months. The percentage of leukopenia in CYP2 C19*2 carriers was lower, and no significant correlation was found, while CYP2 C19*2 polymorphism was significantly associated with abnormal liver function and uterine bleeding. Multivariate logistic regression model analysis showed that CYP2 C19*2 polymorphism and cumulative dosage of cyclophosphamide were independent factors for abnormal uterine bleeding. Conclusion CYP2 C19*2 polymorphism is not uncommon in Chinese Han population and it might lower the risk of some toxicity of cyclophosphamide in SLE patients.
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