DA、5-HT、Cor、ACTH、T 3对双相情感障碍躁狂发作治疗效果的预测价值

Value of DA,5-HT,Cor,ACTH,T3 in Prediction of the Therapeutic Effect of Patients with Bipolar Disorder Manic Episode

目的探讨多巴胺(DA)、5-羟色胺(5-HT)、皮质醇(Cor)、促肾上腺皮质激素(ACTH)、三碘甲状腺原氨酸(T_(3))在双相情感障碍躁狂发作患者疗效预测中的价值。方法选取2019年2月—2021年5月收治的双相情感障碍躁狂发作102例,治疗前、治疗2个月后测定血清DA、5-HT、Cor、ACTH、T_(3)水平、Bech-Rafaelsen躁狂量表(BRMS)、阳性与阴性症状量表(PANSS)评分,依据治疗2个月后疗效分为有效组78例和无效组24例。比较2组一般资料、治疗前后血清DA、5-HT、Cor、ACTH、T_(3)水平,观察各血清学指标与BRMS、PANSS评分及疗效的关系,应用受试者工作特征(ROC)曲线评价血清学指标对患者疗效的预测价值。结果有效组治疗前后血清DA、Cor、ACTH、T_(3)水平与BRMS、PANSS评分均低于无效组,5-HT水平高于无效组(P<0.01);双相情感障碍躁狂发作患者治疗前后血清DA、Cor、ACTH、T_(3)水平与BRMS、PANSS评分呈正相关,血清5-HT水平与BRMS、PANSS评分呈负相关(P<0.01)。治疗前后血清DA、5-HT、Cor、ACTH、T_(3)水平与患者疗效显著相关(P<0.05)。血清DA、5-HT、Cor、ACTH、T_(3)预测患者疗效无效的曲线下面积(AUC)分别为0.798、0.804、0.712、0.719、0.717,各指标联合预测时AUC为0.856,高于单一指标,联合预测敏感度为87.50%,特异度为74.36%。结论双相情感障碍躁狂发作患者血清DA、5-HT、Cor、ACTH、T_(3)呈异常表达,且各指标水平与患者临床症状、疗效有关,应用各指标联合预测可提升疗效预测效能。

Objective To explore the value of dopamine(DA),serotonin(5-HT),cortisol(Cor),adrenocorticotropic hormone(ACTH)and triiodothyronine(T_(3))in prediction of the therapeutic effect of patients with bipolar disorder manic episode(BDME).Methods A total of 102 patients with BDME admitted between February 2019 and May 2021 were selected.Levels of serum DA,5-HT,Cor,ACTH and T_(3),scores of Bech-Rafaelsen manic scale(BRMS)and positive and negative symptom scale(PANSS)before and after treatment for 2 months were detected.The patients were divided into effective group(n=78)and ineffective group(n=24)according to the therapeutic effect after treatment for 2 months.General data,serum levels of DA,5-HT,Cor,ACTH and T_(3) before and after treatment were compared between the two groups.Correlations between serological indexes with scores of BRMS and PANSS and therapeutic effect were observed in each group.The value of serological indexes in prediction of the therapeutic effect of patients was evaluated by receiver operating characteristic(ROC)curve.Results Before and after treatment,in effective group,serum levels of DA,Cor,ACTH and T_(3),scores of BRMS and PANSS were significantly lower,while levels of 5-HT were significantly higher than those in ineffective group(P<0.01).Before and after treatment,serum levels of DA,Cor,ACTH and T_(3) were positively correlated with scores of BRMS and PANSS,while serum levels of 5-HT were negatively correlated with scores of BRMS and PANSS in patients with BDME(P<0.01).Serum levels of DA,5-HT,Cor,ACTH and T_(3) before and after treatment were significantly correlated with the therapeutic effect(P<0.05).The areas under the ROC curve(AUC)of serum DA,5-HT,Cor,ACTH and T_(3) in ineffective prediction of therapeutic effect were 0.798,0.804,0.712,0.719 and 0.717 respectively.The AUC of combined prediction of the above indexes was 0.856,which was higher than that by each one index detection.The sensitivity and specificity of combined prediction were 87.50%and 74.36%respectively.Conclusion Serum DA,5-HT,Cor,ACTH,and T_(3) of patients with BDME are abnormally expressed,and level of each index is related to the patient's clinical symptoms and therapeutic effect.The combined prediction of all indexes may improve the predictive performance of therapeutic effect.