基于DRD4基因遗传多态性和临床资料构建精神分裂症患者攻击行为预测模型  

A prediction model of aggressive behavior in schizophrenics based on genetic polymorphism of DRD4 gene and clinical data

作　　者：邢字航 XING Zihang(The Eighth Hospital of Shijiazhuang City,Shijiazhuang 050000,China)

机构地区：[1]石家庄市第八医院,河北石家庄050000

出　　处：《精神医学杂志》2023年第1期47-52,共6页Journal of Psychiatry

基　　金：石家庄市科技计划项目(编号:171462143)。

摘　　要：目的探讨基于DRD4基因多态性和临床资料构建精神分裂症患者攻击行为预测模型。方法选取精神分裂症患者150例为研究对象,采用修订版外显攻击行为量表(MOAS)分为非攻击组(MOAS加权总分<4分,69例)和攻击组(MOAS加权总分≥4分,81例)。重复片段≥5个的等位基因纳入长片段组,其他等位基因纳入短片段组。收集患者的一般资料,测定患者阳性与阴性症状量表(PNASS)评分,使用PCR检测基因多态位点。Logistic回归分析筛选精神分裂症患者发生攻击性行为的影响因素。构建列线图模型并进行评价。结果攻击组与非攻击组DRD4基因型及等位基因频率分布差异均存在统计学意义(P<0.05)。与非攻击组相比,攻击组中4/6基因型占比、6次重复等位基因占比均较高(P<0.05)。DRD4基因型长片段组PANSS攻击性、思维障碍因子分高于短片段组(P<0.05)。PANSS阳性症状≥18.42分、有既往攻击行为、非自愿住院、基因型4/6、等位基因6次重复、长片段重复序列是精神分裂症患者攻击行为发生的影响因素(P<0.05)。本研究构建的列线图模型的区分度、校准度及临床实用性均较好,且可较好地识别精神分裂症攻击性行为高危患者。结论DRD4基因多态性会影响精神分裂症攻击行为,携带长重复片段等位基因患者症状更严重,更易发生攻击行为。既往攻击行为、PANSS阳性症状、住院形式也是精神分裂症患者攻击行为发生的危险因素。本研究构建列线图模型可较好地识别精神分裂症攻击性行为的高危患者。Objective To establish the prediction model of aggressive behavior in schizophrenics based on genetic polymorphism of DRD4 gene and clinical data.Methods A total of 150 patients with schizophrenia were selected,and according to the scores of Modified Overt Aggression Scales(MOAS),they were divided into non-aggressive group(69 cases,MOAS score<4)and aggressive group(81 cases,MOAS score≥4).The alleles with more than 5 repeat fragments were included in long segment group,and the other alleles were included in short segment group.All the subjects were assessed with general information questionnaire and Positive and Negative Syndrome Scale(PANSS).DRD4 exonⅢ48 bp VNTR polymorphism was detected by polymerase chain reaction(PCR)allele typing.Logistic regression analysis was to screen the influencing factors for the aggressive behavior in schizophrenics.To construct the nomogram model and evaluate it.Results There were significant differences in the distributions of DRD4 genotypes and alleles between non-aggressive group and aggressive group(P<0.05).The proportions of 4/6 genotype and 6 repeat allele in aggressive group were significantly higher than those in non-aggressive group(P<0.05).The factor scores of thinking disorder and aggressiveness of PANSS in long segment group were significantly higher than those in short segment group(P<0.05).The positive symptom score of PANSS≥18.42,previous aggressive behavior,involuntary hospitalization,genotype 4/6,allele 6 repeats and long fragment repeat sequences were independent influencing factors of aggressive behavior in patients with schizophrenia(P<0.05).The nomogram model constructed in this study showed good differentiation,calibration and clinical practicability,and could better identify high-risk patients with aggressive behavior from schizophrenics.Conclusion DRD4 exonⅢ48 bp VNTR polymorphism can affect the aggressive behavior in schizophrenics.Patients with long repeat alleles have more severe symptoms and are more easily prone to aggressive behavior.PANSS positi

关 键 词：精神分裂症 攻击行为 多巴胺D4 临床资料 列线图 

分 类 号：R749.3[医药卫生—神经病学与精神病学]