氧化应激标志物预测SSRIs治疗广泛性焦虑障碍效果的研究  

Predictive value of oxidative stress markers for SSRIs treatment outcomes in patients with generalized anxiety disorder

作　　者：胡瑾瑾[1] 黄卫权[1] 陆梅娟[2] 崔力军[3] HU Jinjin;HUANG Weiquan;LU Meijuan;CUI Lijun(Department of Clinical Laboratory,Huzhou Third Municipal Hospital,Huzhou 313000,China)

机构地区：[1]湖州市第三人民医院检验科,313000 [2]湖州市第三人民医院心身障碍科,313000 [3]湖州市第三人民医院精神医学重点实验室,313000

出　　处：《浙江医学》2024年第23期2515-2520,共6页Zhejiang Medical Journal

基　　金：湖州市科技局公益性应用研究项目(2021GY38)。

摘　　要：目的探讨氧化应激标志物对选择性5-羟色胺再摄取抑制剂(SSRIs)治疗广泛性焦虑障碍(GAD)效果的预测价值。方法回顾性选取2022年1月至12月在湖州市第三人民医院就诊并符合美国《精神障碍诊断与统计手册-5》有关GAD诊断标准的门诊及住院患者152例,其中口服艾司西酞普兰10~20 mg/d患者75例,口服舍曲林50~200 mg/d患者77例,分别于基线期、治疗后8周末采用汉密尔顿焦虑量表(HAMA)对焦虑症状进行评定,根据SSRIs治疗8周末的HAMA评分≤7和>7分为缓解组79例和未缓解组73例。采用酶联免疫吸附试验检测患者治疗前丙二醛(MDA)、超氧化物歧化酶(SOD)、HDL、谷胱甘肽过氧化物酶(GSH-Px)、过氧化氢酶(CAT)、皮质醇、一氧化氮(NO)和脂质过氧化物(LPO)水平。比较缓解组与未缓解组血清氧化应激标志物水平的差异;分析氧化应激标志物与HAMA评分减分率的相关性;采用二元logistic回归分析影响SSRIs疗效的危险因素;采用ROC曲线分析危险因素预测SSRIs治疗缓解率的效能。结果缓解组的血清MDA、LPO水平低于未缓解组,SOD水平则高于未缓解组,差异均有统计学意义(均P<0.05)。缓解组血清MDA、LPO水平与HAMA评分减分率均呈负相关,SOD与HAMA评分减分率呈正相关(均P<0.05)。经二元logistic回归分析显示,在控制一般因素后,GAD患者血清MDA高水平和SOD低水平均是影响SSRIs治疗缓解的危险因素(均P<0.05)。ROC曲线分析显示,MDA、SOD及两者联合预测SSRIs治疗缓解率的AUC分别为0.758、0.661、0.779,MDA、SOD两者联合预测效能高于任意单一指标。结论GAD患者基线期血清MDA高水平、SOD低水平是影响SSRIs 8周末治疗缓解率的危险因素,两者联合检测有更好的预测效能。Objective To explore the predictive value of oxidative stress markers for treatment outcomes of selective serotonin reuptake inhibitors(SSRIs)in patients with generalized anxiety disorder(GAD).Methods A total of 152 patients who met the Diagnostic and Statistical Manual of Mental Disorders-5(DSM-5)criteria for GAD at Huzhou Third Municipal Hospital from January 2022 to December 2022 were enrolled,among them 75 patients took oral escitalopram 10-20 mg/d and 77 patients took oral sertraline 50-200 mg/d for 8 weeks.The Hamilton Anxiety Scale(HAMA)was measured to evaluate anxiety symptoms before and after treatment.Based on HAMA scores≤7 or>7 after 8 weeks of SSRIs treatment,patients were categorized into a remission group(79 cases)or non-remission group(73 cases).The malondialdehyde(MDA),superoxide dismutase(SOD),high-density lipoprotein(HDL),glutathione peroxidase(GSH-Px),catalase,cortisol,nitric oxide(NO),and lipid peroxide(LPO)levels were measured and compare between the remission group and the non-remission group.The correlation of oxidative stress markers with HAMA score reduction was analyzed,and the factors affecting the treatment outcomes of SSRIs were determined with binary logistic regression.The performance of oxidative stress markers in predicting treatment outcomes of SSRIs for GAD patients was evaluated with ROC curve.Results The serum MDA and LPO levels in the remission group were lower than those in the non-remission group,while the SOD level was higher than that in the non-remission group(all P<0.05).The levels of serum MDA and LPO in the remission group were negatively correlated and SOD was positively correlated with the HAMA score reduction rate after treatment(all P<0.05).Binary logistic regression analysis revealed that the high serum MDA level and low SOD level in GAD patients were risk factors for SSRIs treatment remission(all P<0.05).The areas under ROC curve(AUC)of MDA,SOD and their combination in predicting SSRIs treatment response were 0.758,0.661,and 0.779,respectively.The prediction v

关 键 词：广泛性焦虑障碍 氧化应激 选择性5-羟色胺再摄取抑制剂 预测价值 

分 类 号：R749.72[医药卫生—神经病学与精神病学]