药物基因组学在难治性精神分裂症中的应用  

Application of pharmacogenomics in treatment-resistant schizophrenia

作　　者：李丽梅 罗均[1] 何金泉[1] 陈婷 张志旺 LI Limei;LUO Jun;HE Jinquan;CHEN Ting;ZHANG Zhiwang(Department of Clinical Psychology,Chenzhou First People’s Hospital,Chenzhou 423000,Hunan,China)

机构地区：[1]郴州市第一人民医院心理科,湖南郴州423000

出　　处：《中国现代医生》2024年第23期26-29,43,共5页China Modern Doctor

基　　金：湖南省卫生健康委员会卫生科研课题项目(D202303096180)。

摘　　要：目的探讨基于药物基因组学选药和基于循证医学选药对难治性精神分裂症(treatment-resistant schizophrenia,TRS)在疗效及安全性方面的差异。方法选取2023年1月至2023年10月笔者医院就诊TRS患者100例,分为观察组即基因导向选择抗精神病药物组(男22例,女28例)和对照组即循证医学导向选择抗精神病药物组(男23例,女27例)。观察组用采样刷无创采集口腔黏膜上皮细胞行抗精神病药物基因检测,根据检测结果选用正常代谢、应答佳、不良反应小的抗精神病药,对照组由指定医师根据《中国精神分裂症防治指南2015年修订版》选择药物。使用阳性和阴性症状量表(positive and negative syndrome scale,PANSS)在基线时及治疗后第4、8周末进行抗精神病治疗疗效评估。使用治疗中需处理的药物不良反应量表药物不良反应量表(treatment emergent symptom scale,TESS)在治疗后第4、8周末评定不良反应。结果治疗8周末观察组在中枢神经、自主神经、内分泌、心血管、消化方面的不良反应发生率均低于对照组,差异有统计学意义。观察组及对照组在基线时阳性症状、阴性症状、一般精神病理症状得分差异无统计学意义。治疗4周末观察组与对照组的阳性症状、阴性症状、一般精神病理症状得分均低于对照组,差异有统计学意义。治疗8周末观察组与对照组的阳性症状、阴性症状、一般精神病理症状得分差异有统计学意义。治疗后第8周末,观察组的有效率高于对照组,差异有统计学意义(44%vs.24%,P=0.035)。采用两因素重复测量方差分析,提示两组患者基线时、治疗后4周末、8周末PANSS评分随时间而改变,差异有统计学意义(F_(时间)=697.139,P<0.05);PANSS评分组间差异有统计学意义(F_(组间)=5.398,P<0.05);PANSS评分随着治疗方法的不同而有所不同,差异有统计学意义(F_(交互)=3.008,P<0.05)。结论基因导向选择抗精神病药在提Objective To explore the differences in efficacy and safety of drug selection based on pharmacogenomics and evidence-based medicine for treatment-resistant schizophrenia(TRS).Methods A total of 100 patients with TRS in our hospital from January 2023 to October 2023 were divided into observation group(gene-oriented antipsychotic drug selection group,22 males and 28 females)and control group(evidence-based medicine oriented antipsychotic drug selection group,23 males and 27 females).Oral mucosal epithelial cells of the observation group were noninvasive collected with a sampling brush and antipsychotic drug gene detection was performed.Antipsychotic drugs with normal metabolism,good response and little toxic side effects were selected according to the test results,and the drugs of the control group were selected by the designated physician on the basis of the Chinese Guidelines for the Prevention and Treatment of Schizophrenia,2015 revision.Antipsychotic efficacy was evaluated before treatment and 4 weeks,8 weeks after treatment with positive and negative syndrome scale(PANSS).Treatment emergent symptom scale(TESS)was used to assess adverse reactions at the 4th and 8th weekend after treatment.Results After 8 weeks of treatment,the incidence of adverse reactions in central nervous system,autonomic nervous system,endocrine system,circulatory system and digestive system in the control group was higher than that in the observation group.The difference was remarkable.The scores of positive symptoms,negative symptoms and general psychopathological symptoms between the observation group and the control group at baseline were basically the same(P>0.05).After 4 weeks of treatment,the scores of positive symptoms,negative symptoms and general psychopathological symptoms in the observation group were lower than those in the control group.The difference was remarkable.After 8 weeks of treatment,the scores of positive symptoms,negative symptoms and general psychopathological symptoms in the observation group were lower than thos

关 键 词：药物基因组学 个体化用药 难治性精神分裂症 安全性 

分 类 号：R749.3[医药卫生—神经病学与精神病学]