CYP2C19酶多型性与艾司西酞普兰治疗惊恐障碍临床疗效间的关联研究

发布时间：2018-06-07 10:30

本文选题：惊恐障碍 + CYP2C19　；参考：《天津医科大学》2017年硕士论文

【摘要】：目的:本课题旨在探讨惊恐障碍患者CYP2C19基因多态性与艾司西酞普兰治疗临床疗效间的关联。方法:严格依照DSM-V诊断标准,选取满足条件的惊恐障碍患者,选取与之性别、年龄、学历相匹配的正常对照作为研究对象。选用PDSS-CV、HAMA-14量表在基线、治疗2周、治疗4周和8周评定临床症状。入组后的患者均服用艾司西酞普兰10mg/qd治疗,研究的8周内不得服用其他抗抑郁剂,不使用苯二氮卓类如罗拉等,不使用氯硝西泮、硝基西泮等药物。抽取入组患者外周静脉全血,提取基因组DNA,用人类CYP2C19基因多态性检测试剂盒(PCR-荧光探针法)检测CYP2C19基因636、681两个位点的基因多态性。运用SPSS17.0统计软件包进行数据分析。结果:1病例组与对照组人口统计学资料分布差异无统计学意义。说明病例组与对照组性别、年龄、婚姻、教育程度、职业、长期居住地、吸烟、饮酒相匹配。2病例组与对照组CYP2C19基因型和代谢型的频率分布比较,差异无统计学意义(P0.05)。3比较病例组患者不同代谢型间的一般资料,病例组CYP2C19酶的EM、IM、PM三种代谢型在性别、年龄、婚姻、教育程度、职业、长期居住地、吸烟、饮酒的分布差异无统计学意义(P0.05)。4比较CYP2C19不同代谢型患者艾司西酞普兰治疗不同治疗阶段的PDSS-CV量表减分率,在治疗第四周和第八周时,三种代谢型PDSS-CV量表减分率有统计学差异(P0.05),每种代谢型治疗后比治疗前PDSS-CV量表评分有统计学差异(P0.05)。5比较CYP2C19不同代谢型患者艾司西酞普兰治疗不同治疗阶段的HAMA-14量表减分率,在治疗第四周和第八周时,三种代谢型HAMA-14量表减分率有统计学差异(P0.05),每种代谢型治疗后比治疗前HAMA-14量表评分有统计学差异(P0.05)。6以PD患者在艾司西酞普兰不同治疗阶段以PDSS-CV量表减分率≥40%为惊恐症治疗有效。以HAMA-14量表减分率≥50%为焦虑症状治疗有效。CYP2C19三种代谢型在不同治疗阶段DSS-CV与HAMA-14量表治疗有效数均在第二周第四周有统计学差异(P0.05)。7认知功能学习-记忆能力中的HVLTR总分与PDSS-CV基线总分存在显著相关性(P0.05)。8处理速度中的符号编码评分与HAMA-14 2w评分存在相关性(P0.05)。9惊恐障碍患者的认知功能与STAI量表基线总分、PHQ9量表基线总分等未发现存在显著相关性(P0.05)。结论:1在艾司西酞普兰治疗第四周和第八周时,慢代谢型的病人减分率比其他代谢型减分率高,说明携带慢代谢型的病人在第四和第八周惊恐症状改善更好。2在艾司西酞普兰治疗第四周和第八周时,慢代谢型的病人减分率比其他代谢型减分率高,说明携带慢代谢型的病人在第四和第八周焦虑症状改善更好。3以PD患者在艾司西酞普兰不同治疗阶段以PDSS-CV量表减分率≥40%为惊恐症治疗有效。以HAMA-14量表减分率≥50%为焦虑症状治疗有效。CYP2C19三种代谢型在不同治疗阶段DSS-CV与HAMA-14量表治疗有效数均在第二周第四周,慢代谢型病人早期起效率比其他代谢型比率高。4三种代谢型惊恐症状和焦虑症状与基线比都有所改善。5病例组CYP2C19酶的EM、IM、PM三种代谢型的性别、年龄、婚姻、教育程度、职业、长期居住地、吸烟、饮酒与艾司西酞普兰治疗临床疗效无关。6病例组与对照组人口统计学资料分布差异无统计学意义。说明性别、年龄、婚姻、教育程度、职业、长期居住地、吸烟、饮酒与惊恐障碍发生无关。7病例组的CYP2C19基因型和代谢型的频率分布与对照组无明显差异。8认知功能学习-记忆能力中的霍普金斯语言学习测验总分与惊恐障碍基线严重程度存在相关性。9认知功能处理速度中的符号编码评分与第二周的焦虑症状存在相关性。10没有发现认知功能与基线状态特质焦虑、抑郁症状及生活质量等存在相关性。
[Abstract]:Objective: To explore the relationship between the polymorphism of CYP2C19 gene and the clinical efficacy of Ai Sciplan in the patients with panic disorder. Methods: strictly according to the criteria of DSM-V diagnosis, select the patients with the condition of panic disorder, select the normal controls that match the sex, age, and educational background. Select the PDSS-CV, HAMA-14 scale At baseline, 2 weeks of treatment, treatment for 4 and 8 weeks, the clinical symptoms were evaluated. The patients after the group were treated with Ai Sciplan 10mg/qd, and no other antidepressants were taken in the study for 8 weeks, no use of benzene two azo like Rolla, and no clonazepam, nitrosiazepam and other drugs. The whole blood of the peripheral vein was extracted and extracted from the group of DNA. CYP2C19 gene polymorphism detection kit (PCR- fluorescence probe) was used to detect the gene polymorphism of 636681 CYP2C19 loci in two loci. The data were analyzed by SPSS17.0 software package. The results showed that there was no statistical difference between the 1 case group and the control group. The results showed that the sex, age, marriage of the case group and the control group were in marriage. Marriage, education, occupation, long-term residence, smoking, drinking and matching.2 case group with the control group CYP2C19 genotype and metabolic frequency distribution, the difference was not statistically significant (P0.05).3 compared with the case group patients with different metabolic type general data, the case group CYP2C19 enzyme EM, IM, PM three metabolic types in sex, age, marriage, education. Degree, occupation, long-term residence, smoking and drinking, there was no significant difference in distribution (P0.05).4 compared with the PDSS-CV scale reduction rate of different metabolic patients Ai Sciplan treated at different treatment stages, and at the fourth and eighth weeks of treatment, the reduction rate of the three metabolic PDSS-CV scales was statistically different (P0.05), each type of metabolic type. After treatment, there was a statistical difference compared with the PDSS-CV scale before treatment (P0.05).5 compared to the HAMA-14 scale reduction rate of different metabolic patients with different metabolic types by Ai Sciplan, and at the fourth and eighth weeks of treatment, the reduction rate of the three metabolic HAMA-14 scales had a systematic difference (P0.05), and each metabolic therapy was compared to the treatment after treatment. The scores of the former HAMA-14 scale were statistically different (P0.05).6 for PD patients in the different stages of the treatment of alcitalopram with the PDSS-CV scale subtraction rate of more than 40% for the treatment of panic disorder. The reduction rate of the HAMA-14 scale was more than 50% for the anxiety symptoms and the effective.CYP2C19 three metabolic types were treated with DSS-CV and HAMA-14 at different stages of treatment. There was statistical difference between second weeks (P0.05).7 cognitive function learning - memory ability, there was significant correlation between HVLTR total score and PDSS-CV baseline total score (P0.05) the symbol coding score in.8 processing speed and HAMA-14 2W score had correlation (P0.05).9 panic disorder patients' cognitive function and STAI scale baseline total score, PHQ9 scale base No significant correlation was found in total line score (P0.05). Conclusion: 1 in the four weeks and eighth weeks of escitalopram treatment, the rate of subtraction in slow metabolic patients is higher than that of other metabolic type, indicating that the patients with slow metabolic type improve the panic symptoms in fourth and eighth weeks and better.2 in the four weeks and eighth weeks of the treatment of escitalopram. In patients with slow metabolic type, the rate of subtraction was higher than that of other metabolic type, indicating that the anxiety symptoms improved in the fourth and eighth weeks of the patients with the slow metabolic type were better.3 and the reduction rate of the PDSS-CV scale was more than 40% for the PD patients at different stages of esmolitalopram treatment. The reduction rate of the HAMA-14 scale was more than 50% for the anxiety symptoms. The effective number of effective.CYP2C19 three metabolic types at different stages of DSS-CV and HAMA-14 was second weeks. The early efficiency of the slow metabolic patients was higher than that of other metabolic types,.4 three kinds of metabolic panic symptoms and anxiety symptoms and baseline ratio both improved the EM, IM, PM and three metabolic types of the CYP2C19 enzyme in the.5 case group. Gender, age, marriage, education, occupation, long-term residence, smoking, drinking and the clinical efficacy of Ai Sciplan were not statistically significant differences in the distribution of demographic data between the.6 case group and the control group. It showed that sex, age, marriage, education, vocational, long-term residence, smoking, drinking and panic disorder were not related to.7's disease. There was no significant difference in the frequency distribution of CYP2C19 genotype and metabolic type between the control group and the control group. There was a correlation between the total score of Hopki language learning test in.8 cognitive function learning memory ability and the baseline severity of panic disorder. The symbol coding score of.9 cognitive function processing was associated with the correlation of second weeks of anxiety symptoms,.10 No correlation was found between cognitive function and baseline state trait anxiety, depressive symptoms and quality of life.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R749.7

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