依据ADRA2A和MDGA2基因多态性指导米那普仑治疗抑郁症的疗效观察  

Observation on the Efficacy of Milnacipran in the Treatment of Depression According to ADRA2A and MDGA2 Gene Polymorphism

作　　者：钱兴山 张新风[1,2] 涂哲明 涂清芬[3] 彭海燕 邓小鹏[1,2] 刘波[1,2] Qian Xingshan;Zhang Xinfeng;Tu Zheming;Tu Qingfen;Peng Haiyan;Deng Xiaopeng;Liu Bo(Jingzhou Mental Health Center,Jingzhou 434000,Hubei,China;Mental Health Institute of Yangtze University;Jingzhou First People’s Hospital)

机构地区：[1]荆州市精神卫生中心,湖北荆州434000 [2]长江大学精神卫生中心研究所 [3]荆州市第一人民医院神经内科

出　　处：《药物流行病学杂志》2020年第10期675-679,720,共6页Chinese Journal of Pharmacoepidemiology

基　　金：荆州市医疗卫生科技计划项目(编号:20152497)。

摘　　要：目的:在药物基因检测确定ADRA2A和MDGA2的基因多态性基础上,对服用米那普仑治疗的抑郁症患者实施个体化治疗,探讨临床疗效与安全性。方法:抑郁症患者随机分为研究组(80例)与对照组(87例)。研究组患者经药物基因检测,选择55例ADRA2A基因突变杂合型(CG)和MDGA2基因突变型(CC)作为"推荐使用"患者入组;对照组经三级医师查房经验用药,纳入68例。两组均给予米那普仑片治疗。采用汉密尔顿抑郁量表(HAMD-17)评价治疗后0,2,4,8周的临床效果;采用药物副反应量表(TESS)评价药品不良反应。结果:治疗4周后,研究组患者的HAMD-17总分及各因子评分均较治疗前显著降低(P<0.05),而对照组患者仅总分、睡眠因子评分明显降低(P<0.05);治疗8周后,两组患者的HAMD-17总分及各因子评分均较治疗前显著降低(P<0.05),而研究组HAMD-17总分、抑郁因子、焦虑/躯体症状因子等评分显著低于对照组(P<0.05)。研究组患者的TESS量表总分及药品不良反应发生率均明显低于对照组(P<0.05)。结论:治疗前行基因多态性检测并实施米那普仑个体化治疗,可快速有效改善抑郁症症状,减少药品不良反应。Objective:To adopt individualized treatment for depression patients treated with minalpran and to explore the clinical efficacy and safety of on the basis of gene polymorphism of ADRA2 A and MDGA2 determined by drug gene detection. Methods:Patients with depression were randomly divided into the observation group(80 cases) and the control group(87 cases). Observation group patients were performed by drug gene test, 55 patients with ADRA2 A mutant(CG) and MDGA2 mutant(CC) were enrolled as "recommended use" patients. Patients in the control group took medicine according to the experience in ward rounds of tertiary physicians, and 68 cases were included. Both two groups were treated with milnacipran tablets. The Hamilton depression scale(HAMD-17) was used to evaluate the clinical effects at 0, 2, 4, and 8 weeks after treatment;the treatment emergent symptom scale(TESS) was used to evaluate the adverse drug reactions. Results:After 4 weeks of treatment, the total score of HAMD-17 and the scores of each factor of the observation group were significantly lower than those before treatment(P<0.05), while the total score and sleep factor score of the control group were significantly lower(P<0.05). After 8 weeks of treatment, the total scores of HAMD-17 and the scores of various factors of patients in the two groups were significantly lower than those before treatment(P<0.05);The total scores of the HAMD-17, depression factors, and anxiety/physical symptoms factors of the observation group were significantly lower than those in the control group(P<0.05). The total score of TESS scale and the incidence of adverse drug reactions in the observation group were significantly lower than those in the control group(P<0.05). Conclusion:Detection of gene polymorphism before treatment and individualized treatment of milnacipran could quickly and effectively improve depression symptoms and reduce adverse drug reactions.

关 键 词：ADRA2A基因 MDGA2基因 基因多态性 米那普仑 抑郁症 个体化治疗 

分 类 号：R971.43[医药卫生—药品]