抑郁症患者无抽搐电休克治疗的疗效与脑源性神经营养因子基因多态性

Relationship between the effect of modified electroconvulsive therapy and brain-derived neurotrophic factor(BDNF) gene polymorphism in patients with major depressive disorder

目的：探讨抑郁症患者脑源性神经营养因子（brain-derived neurotrophic factor, BDNF）基因两个单核苷酸多态性位点的多态性与无抽搐电休克治疗（ modified electroconvulsive therapy, MECT）疗效的关系。方法：采用病例对照研究，研究组为110例符合美国精神障碍诊断统计手册第4版（ Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, DSM-IV ）抑郁症诊断标准的门诊及住院患者，对照组为100名正常人。患者入组后连续接受MECT8次，使用汉密顿抑郁量表（Hamilton Depression Rating Scalefor Depression，HRSD）进行抑郁严重程度及疗效评估。运用PCR扩增及测序的方法，分析BD—NF基因rs6265、rs7103411单核苷酸多态性的分布，分析rs6265、rs7103411基因型及等位基因频率分布与MECT疗效的关系。结果：BDNF基因rs6265、rs7103411位点基因型及等位基因频率在对照组与患者组间的差异无统计学意义，MECT后2个位点基因型及rs7103411等位基因频率在不同疗效组间的差异无统计学意义。rs6265位点A等位基因频率和G等位基因频率在减分率／〉50％组分别为47．9％、52．1％；在减分率〈25％组分别为27．5％、72．5％，两组比较差异有统计学意义（P〈0．05），且A等位基因对MECT反应好于G等位基因（OR=1．740，95％CI：1．022～2．963）。结论：病情严重的抑郁症患者BDNF基因rs6265位点A等位基因可能与无抽搐电休克治疗效果有关，A等位基因携带者接受MECT的疗效较G等位基因携带者好。

Objective： To explore the relation of brain-derived neurotrophic factor （BDNF） polymorphisms with the response to modified electroconvulsive therapy （MECT） in patients with major depressive disorder （MDD） . Methods ： In this study, 110 patients with major depression were selected according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria, and 100 healthy person were used as con- trois. The patients received MECT 8 times consecutively and were assessed with the Hamilton Depression Rating Scale for Depression （HRSD） . Using direct sequencing after polymerase chain reaction （PCR）, the single nucleotide polymorphism （SNP） of the BDNF gene rs6265, rs7103411 were identified. And the BDNF gene rs6265, rs7103411 genotype and allele frequency were counted. Results： Neither of these BDNF polymorphisms had significant differences between the healthy controls and depressive patients. And the two single nueleotide polymorphism sites were not associated with the response to MECT. In addition, no significant differences were found in the genotypes concerning the MECT response and allele of rs7103411. However, the significant differences in the A allele frequency of rs6265 were found, and the frequencies of A and G allele were respectively 47. 9% and 52. 1% in reducing rates≥50% group, 27. 5% and 72.5% in reducing rates 〈25% group （P 〈0. 05）. The data showed a significant positive correlation between frequencies of A allele and MECT curative effect （ OR = 1. 740, 95% CI = 1. 022 -2. 963） . Conclusion： The rs6265 site A allele of BDNF gene may be relevant with the thera- peutic efficacy of MECT in patients with major depressive disorder. The A allele carriers may have better efficacy of MECT than the G allele carriers.