CYP2C19基因型检测对艾司西酞普兰治疗抑郁症的临床意义及成本效益研究

Study on the clinical significance and cost-effectiveness of CYP2C19 genotype testing for escitalopram in the treatment of depression

目的研究CYP2C19基因型检测对艾司西酞普兰治疗抑郁症的临床意义及成本效益。方法根据纳入标准,将急性发作期抑郁症患者随机分为检测组83例及非检测组76例。检测组根据CYP2C19基因型决定西酞普兰起始服药剂量,非检测组按说明书常规服药。每例患者评定基线和治疗4周后的Hamilton抑郁量表(HAMD)得分,计算减分率。比较检测组与非检测组的治疗有效率、日均服药剂量、不良反应发生率。统计治疗成本,比较组间成本和成本-效果的差异。结果检测组疗效显著比例为62.65%(52/83),明显高于非检测组的46.05%(35/76),差异有统计学意义(χ^2=4.41,P=0.04)。检测组服药剂量为(13.16±3.27)mg/d,明显低于非检测组的(15.47±2.79)mg/d,差异有统计学意义(t=4.78,P<0.001)。检测组口干、疲劳和便秘的发生率明显低于非检测组,差异均有统计学意义(P<0.05)。非检测组每降低1个单位HAMD得分,需要花费470.16元,而检测组只需354.27元。结论CYP2C19基因型检测在艾司西酞普兰治疗抑郁症过程中,可提高临床收益并降低治疗成本。

Objective To study the clinical significance and cost-effectiveness of CYP2C19 genotype detection for escitalopram in the treatment of depression.Methods According to the inclusion criteria,patients with acute-onset depression were randomly divided into detection group with 83 cases and non-detection group with 76 cases.The test group determined the initial dose of citalopram based on the CYP2C19 genotype,and the non-test group took the drug according to the instructions.Each patient evaluated the Hamilton Depression Rating Scale(HAMD)score at baseline and 4 weeks after treatment,and calculated the reduction rate.The treatment efficiency rate,average daily dose,and incidence rate of adverse reactions between the detection group and the non-detection group were compared.The cost of treatment was calculated to compare the differences in cost and cost-effectiveness between groups.Results The significant proportion of curative effect in the detection group was 62.65%(52/83),which was significantly higher than 46.05%(35/76)in the non-detection group.The difference was statistically significant(χ^2=4.41,P=0.04).The dose of the test group was(13.16±3.27)mg/d,which was significantly lower than the(15.47±2.79)mg/d of the non-test group,and the difference was statistically significant(t=4.78,P<0.001).The incidence rate of dry mouth,fatigue and constipation in the test group was significantly lower than that of the non-test group,and the differences were statistically significant(P<0.05).It would cost 470.16 yuan for the non-detection group to reduce the HAMD score by 1 unit,while the detection group only needed 354.27 yuan.Conclusion CYP2C19 genotype testing can improve clinical benefits and reduce treatment costs during the treatment of depression with escitalopram.