文法拉辛对首发广泛性焦虑障碍合并代谢综合征患者治疗作用及代谢的影响  

Therapeutic effects and metabolic impact of venlafaxine on patients with initial generalized anxiety disorder complicated with metabolic syndrome

作　　者：周俊[1] 丁虎 ZHOU Jun;DING Hu(Psychiatry Ward 5,Hainan Anning Hospital,Haikou 570100,Hainan Province,China)

机构地区：[1]海南省安宁医院精神科五病区,海南海口570100

出　　处：《中国临床药理学杂志》2023年第16期2334-2338,共5页The Chinese Journal of Clinical Pharmacology

基　　金：海南省自然科学基金资助项目(821MS0841)。

摘　　要：目的探究治文拉法辛对首发广泛性焦虑障碍(GAD)合并代谢综合征(MS)患者的代谢水平的影响。方法选择首发GAD合并MS的并使用文拉法辛进行治疗的患者为受试者。对患者进行脂联素基因单核苷酸多态性(SNP)位点(rs266729)检测,并根据基因分型进行指标分析。收集受试者于治疗前和用药治疗后相关指标,包括:体质量指数(BMI)、空腹血糖(FPG)、汉密尔顿焦虑量表评分(HAMA)、三酰甘油(TG)、血清高密度脂蛋白胆固醇(HDL-C)、血清低密度脂蛋白胆固醇(LDL-C)和脂联素(ANP)。通过统计治疗前后HAMA的减分率对所有受试者进行疗效评价,并收集用药期间发生的药物不良反应情况。结果因中途退出研究和未能坚持用药治疗原因脱落24例,最终有53例患者纳入统计分析,其中9.40%(5例/53例)为G/G基因型,47.20%(25例/53例)为G/C基因型,43.40%(23例/53例)为C/C基因型,基因型分布均在HWE范围内(均P>0.05)。治疗后的FPG水平[(8.27±0.78)mmol·L^(-1)]、HAMA评分[(6.94±1.76)分]以及ANP水平[(6.16±0.63)mg·L^(-1)]与治疗前的FPG水平[(6.21±0.74)mmol·L^(-1)]、HAMA评分[(24.79±4.97)分]以及ANP水平[(8.14±0.69)mg·L^(-1)]比较,差异均有统计学意义(均P<0.05)。根据HAMA评分的减少率结果显示,不同基因型的患者在使用文拉法辛治疗广泛性焦虑症(GAD)时均表现出明显的疗效,但G/G、G/C和C/C不同基因型之间比较,差异均无统计学意义(均P>0.05)。本次研究中患者出现的药物不良反应主要有胃肠道问题、头痛、睡眠障碍、出汗以及泌尿系统问题。G/G、G/C和C/C不同基因型患者总药物不良反应发生率分别为60.00%(3例/5例)、48.00%(12例/25例)、52.17%(12例/23例),差异均无统计学意义(均P>0.05)。结论首次诊断为GAD合并MS的患者使用文拉法辛治疗,可能影响患者的血糖和ANP水平,从而加重MS病情,但与患者ANP基因SNP rs266729多样性无关。Objective To explore the effect of venlafaxine on the metabolic level of patients with first-episode generalized anxiety disorder(GAD)complicated with metabolic syndrome(MS).Methods Patients with first-episode GAD combined with MS and treated with venlafaxine were selected as the study subjects.The single nucleotide polymorphism(SNP)locus(rs266729)of adiponectin gene was detected in the patients,and the indexes were analyzed according to the genotyping.The relevant indicators of the subjects before and after treatment were collected,including body mass index(BMI),fasting blood glucose(FPG),Hamilton anxiety scale score(HAMA),triglyceride(TG),serum high-density lipoprotein cholesterol(HDL-C),serum low-density lipoprotein cholesterol(LDL-C)and adiponectin(ANP).The efficacy of all subjects was evaluated by the reduction rate of HAMA before and after treatment,and the adverse drug reactions occurred during the treatment were collected.Results Twenty-four patients dropped out of the study due to withdrawal from the study and failure to adhere to drug treatment.Finally,53 patients were included in the statistical analysis,of which 9.40%(5/53 cases)were G/G genotype,47.20%(25/53 cases)were G/C genotype,and 43.40%(23/53 cases)were C/C genotype group.The genotype distribution was within the scope of HWE(all P>0.05).There were significant differences in FPG level[(8.27±0.78)mmol·L^(-1)],HAMA score[(6.94±1.76)]and ANP level[(6.16±0.63)mg·L^(-1)]after treatment compared with FPG level[(6.21±0.74)mmol·L^(-1)],HAMA score[(24.79±4.97)]and ANP level[(8.14±0.69)mg·L^(-1)]before treatment(all P<0.05).According to the reduction rate of HAMA score,the results showed that patients with different genotypes showed significant efficacy in the treatment of generalized anxiety disorder(GAD with venlafaxine,but there was no significant difference between different genotypes of G/G,G/C and C/C(all P>0.05).The adverse drug reactions in this study mainly included gastrointestinal problems,headache,sleep disorders,sweating and urinary

关 键 词：文拉法辛 广泛性焦虑障碍 代谢综合征 血清脂联素 脂联素基因多态性 

分 类 号：R971[医药卫生—药品]