血清色氨酸羟化酶糖原合成酶激酶3β水平对拉莫三嗪精准用药治疗青少年双相障碍抑郁发作的效果评估  

Evaluation value of serum TPH and GSK-3βlevels in the precision treatment of lamotrigine for adoles-cent bipolar disorder depression episodes

作　　者：刘立滢 郑胜丽 陈光东 Liu Liying;Zheng Shengli;Chen Guangdong(Department of Psychiatry,Seventh People′s Hospital of Wenzhou,Wenzhou,Zhejiang 325000,China)

机构地区：[1]浙江省温州市第七人民医院精神科,浙江温州325000

出　　处：《中国药物与临床》2024年第13期857-861,F0003,共6页Chinese Remedies & Clinics

基　　金：浙江省温州市科研项目(Y20220844)。

摘　　要：目的探讨血清色氨酸羟化酶(TPH)、糖原合成酶激酶3β(GSK-3β)水平评估拉莫三嗪精准用药治疗青少年双相情感障碍(BD)抑郁发作疗效的价值。方法回顾性收集2022年6月至2023年4月浙江省温州市第七人民医院收治的187例青少年BD抑郁发作患儿临床资料,所有患儿均接受拉莫三嗪精准用药治疗,治疗4周评价治疗效果。根据治疗效果将患儿分为有效组与无效组,比较2组患儿基线资料、治疗前血清TPH、GSK-3β水平。用双变量Pearson相关分析血清TPH、GSK-3β水平的相关性;经Logistic回归分析治疗前血清TPH、GSK-3β水平对拉莫三嗪精准用药治疗BD抑郁发作疗效的影响;绘制受试者工作特征(ROC)曲线和决策曲线,分析治疗前血清TPH、GSK-3β水平对拉莫三嗪精准用药治疗BD抑郁发作疗效的预测评估价值。结果187例BD抑郁发作青少年患儿经拉莫三嗪精准用药治疗4周,有效156例,无效31例,有效率为83.4%。无效组患儿治疗前血清TPH水平低于有效组,血清GSK-3β水平高于有效组(t=6.920、4.648,P<0.001)。经双变量Pearson相关分析显示,BD抑郁发作患儿治疗前血清TPH、GSK-3β水平呈负相关(r=-0.173,P=0.018)。经多项Logistic回归分析结果显示,治疗前血清TPH、GSK-3β是拉莫三嗪精准用药治疗BD抑郁发作疗效的独立危险因子(P<0.05)。ROC曲线显示,血清TPH、GSK-3β水平单独及联合预测评估BD抑郁发作患儿疗效的曲线下面积>0.70,具有一定的预测评估价值。决策曲线显示,在阈值0~1.0内,治疗前血清TPH、GSK-3β联合预测评估拉莫三嗪精准用药治疗BD抑郁发作患儿疗效的净收益率优于单独的净收益率,且净收益率>0,有临床意义。结论血清TPH、GSK-3β水平对拉莫三嗪精准用药治疗青少年BD抑郁发作疗效具有良好的预测评估价值。Objective To explore the value of serum tryptophan hydroxylase(TPH)and glycogen synthase kinase 3β(GSK-3β)levels in evaluating the efficacy of lamotrigine precise therapy for depressive episodes in adolescents with bipolar disorder(BD).Methods A retrospective study was conducted to collect clinical data of 187 adolescent patients with bipolar disorder(BD)depression episodes admitted to the Seventh People′s Hospital of Wenzhou from June 2022 to April 2023.Received precision therapy with lamotrigine,and the treatment effect was evaluated after 4 weeks of treatment.According to the treatment effect,the patients were divided into an ef-fective group and an ineffective group.The baseline data,serum TPH and GSK-3βlevels before treatment were compared between the two groups.The correlation between serum TPH and GSK-3βlevels was tested using bi-variate Pearson correlation analysis.The impact of serum TPH and GSK-3 before treatment on the efficacy of pre-cision therapy with lamotrigine for BD depression episodes was analyzed.Furthermore,the predictive value of serum TPH and GSK-3βlevels before treatment in assessing the efficacy of precision therapy with lamotrigine for BD depression episode was alaso analyzed.Results A total of 187 adolescent patients with BD depression episodes were treated with precision therapy using lamotrigine for 4 weeks,156 cases were effective,31 cases were ineffective,with an effective rate of 83.4%.The serum TPH level before treatmeng in the ineffective group was lower than that in the effective group,while the serum GSK-3βlevel was higher than that in the effective group(t=6.920,4.648,P<0.001).Bivariate Preason correlation analysis showed that a negative correlation between serum TPH and GSK-3βlevels before treatment in children with BD depressive episodes(r=-0.173,P=0.018).Multivariate logistic regression analysis revealed that serum TPH and GSK-3βlevels before treatment were inde-pendent risk factors for the efficacy of precision therapy with lamotrigine for BD depressive episodes(

关 键 词：双相情感障碍 青少年 拉莫三嗪 色氨酸羟化酶 糖原合成酶激酶3Β 

分 类 号：R749.4[医药卫生—神经病学与精神病学]