【摘要】 目的:研究患者5-羟色胺1A/2A(5-HTR1A/2A)基因多态性与选择性5-羟色胺再摄取抑制剂(SSRI)类药物(SSRIs)抗抑郁疗效的相关性,为SSRIs的合理使用提供参考。方法:采用前瞻性研究方法,选取2016年10月-2017年10月内蒙古自治区人民医院精神专科符合入组标准的85例抑郁症住院患者,随机口服SSRIs帕罗西汀或舍曲林或艾司西酞普兰中的任意一种进行治疗,治疗周期为8周。以汉密尔顿焦虑量表(HAMD)评分计算所得患者治疗后的HAMD减分率为标准,分为有效组(HAMD减分率≥50%)和无效组(HAMD减分率<50%)。采用χ2检验分析两组患者5-HTR1A(rs6295)、5-HTR2A(rs6313、rs6311)的基因型分布和基因分布频率的差异,t检验比较有显著影响基因型对HAMD减分率的影响。结果:有效组患者45例,无效组患者40例,两组患者间民族、性别、年龄差异均无统计学意义(P>0.05)。两组患者5-HTR1A(rs6295)等位基因G、C的分布频率差异有统计学意义(χ2=13.75,P<0.001),基因型分布差异无统计学意义(χ2=4.72,P=0.09);5-HTR2A(rs6313)等位基因G、A和5-HTR2A(rs6311)等位基因C、T的分布频率差异均有统计学意义(χ2=15.20、15.20,P<0.001),基因型分布差异也均有统计学意义(χ2=23.68、23.68,P<0.001)。5-HTR2A(rs6313)G/A、G/G、A/A 3种基因型患者间HAMD减分率差异无统计学意义(P>0.05)。5-HTR2A(rs6311)T/T与C/C、T/T与C/T基因型患者间HAMD减分率差异无统计学意义(P>0.05),仅C/C基因型患者HAMD减分率明显高于C/T基因型患者(P=0.02)。结论:5-HTR2A(rs6313、rs6311)基因多态性可能与SSRIs治疗抑郁症的临床疗效有关,其中5-HTR2A(rs6311)C/C基因型有希望作为SSRIs治疗抑郁症时判别疗效的预测因子。更多还原

【Abstract】 OBJECTIVE:To study the association of 5-HTR1 A/2 A receptor gene polymorphism with antidepressant efficacy of selective 5-serotonin reuptake inhibitors(SSRIs),and to provide reference for rational use of SSRIs. METHODS:In perspective study,85 depressive inpatients met inclusion criteria were selected from Inner Mongolia Autonomous Region People’s Hospital during Oct. 2016-Oct. 2017. They were randomly given one kind of SSRIs as paroxetine,sertraline or escitalopram oxalate,for 8 weeks. They were divided into valid group(HAMD reduction rate≥50%) and invalid group(HAMD reduction rate<50%)according to HAMD reduction rate calculated by HAMD score after treatment. Difference of genotype distribution and genotype distribution frequency of 5-HTR1 A(rs6295) and 5-HTR2 A(rs6313, rs6311) were analyzed by χ2-test in 2 groups. t-test comparison significantly influenced the effects of genotype on HAMD reduction rate. RESULTS:There were 45 patients in valid group and 40 patients in invalid group;there was no statistical significance in the difference in nationality,gender or age between2 groups(P>0.05). There was statistical significance in the distribution frequency of 5-HTR1 A(rs6295)allele G and C between 2 groups(χ2=13.75,P<0.001);there was no statistical significance in genotype distribution(χ2=4.72,P=0.09). There was statistical significance in the distribution frequency of 5-HTR2 A(rs6313)allele G and A with 5-HTR2 A(rs6311)allele C and T(χ2=15.20,15.20,P<0.001). There was statistical significance in difference of genotype distribution(χ2=23.68,23.68,P<0.001).There was no statistical significance in HAMD reduction rate among 5-HTR2 A(rs6313)G/A, G/G, A/A genotypes(P>0.05). There was no statistical significance in HAMD reduction rate between 5-HTR2 A(rs6311)T/T genotype and C/C genotype,between 5-HTR2 A(rs6311)T/T genotype and C/T genotype(P>0.05). HAMD reduction rate of C/C genotype was significantly higher than that of C/T genotype(P=0.02).CONCLUSIONS: 5-HTR2 A(rs6313, rs6311) gene polymorphism may be associated with clinical efficacy of SSRIs for depression. 5-HTR2 A(rs6311)C/C genotype is hopeful as a efficacy predictor of SSRIs in the treatment of depression.更多还原