氯米帕明对强迫症患者脑脊液中5-HT及5-HIAA表达水平的影响

Effects of clomipramine on the expression level of CSF 5-HT and 5-HIAA of OCD patients

目的探讨强迫症患者应用氯米帕明治疗前后脑脊液中5-羟色胺、5-羟吲哚乙酸表达水平的变化，分析临床疗效与5-羟色胺、5-羟吲哚乙酸表达水平的关系。方法对36例强迫症患者予以口服氯米帕明治疗，观察12周。治疗前后采用耶鲁-布朗强迫量表评定临床疗效，检测脑脊液中5-羟色胺、5-羟吲哚乙酸表达水平，并进行相关分析。结果本组患者治疗后耶鲁-布朗强迫量表总分较治疗前显著下降（P〈0．01），治疗12周末有效率为57．6％（19／33）。有效患者治疗前脑脊液中5-羟吲哚乙酸表达水平显著高于无效患者（P〈0．05）。有效患者治疗后脑脊液中5-羟吲哚乙酸表达水平较治疗前显著下降（P〈0．05），5-羟色胺表达水平与治疗前比较差异无显著性（P〉0．05）。有效患者耶鲁-布朗强迫量表总分减分率与脑脊液中5-羟吲哚乙酸表的变化值呈正相关（r＝0．62，P〈0．01），与5-羟色胺变化值无相关性。结论强迫症患者经氯米帕明治疗后其脑脊液中5-羟吲哚乙酸表达水平下降，其表达水平下降与疗效呈正相关。脑脊液中5-羟吲哚乙酸表达水平可能是判断强迫症患者疗效的-个重要指标，其敏感性优于5-羟色胺。

Objective To explore the changes of expression level of CSF 5-HT and 5-HIAA of OCD pa- tients before and after clomipramine treatment and analyze the relationship between curative effect and the expression level of 5-HT and 5-HIAA. Methods mine for 12 weeks. Before and after treatment Thirty-six OCD patients were treated with oral clomipra- efficaeies were assessed with the Yale-Brown Obsessive- Compulsive Scale （Y-BOCS）, expression levels of CSF 5-HT and 5-HIAA detected, and correlation analy- ses carried out. Results After treatment the total score of the Y-BOCS lowered more significantly com- pared with pretreatment （P〈0.01）, at the end of the 12th week effective rate was 57.6% （19/33）. Before treatment 5-HIAA expression level was significantly higher in patients whose treatment were effective than ones ineffective （P〈0.05）. After treatment 5-HIAA expression level lowered more significantly compared with pretreatment in patients whose treatment were effective （P〈0.05）, there was no significant differ- ence in 5-HT （P〉0.05）. The reducing score rate of the Y-BOCS total score was positively related to the change value of CSF 5-HIAA expression level in patients whose treatment were effective （r= 0.62, P〈 0.01） and had no correlation to 5-HT. Conclusion CSF 5-HIAA expression levels of OCD patients lower after clomipramine treatment, the drop of 5-HIAA expression levels is positively related to curative effect. CSR 5-HIAA expression level may be an important index judging curative effect of OCD patient and its sensitivity is higher compared with 5-HT.