CYP2C19基因多态性对艾司西酞普兰治疗抑郁症伴焦虑症状疗效的影响

Effect of CYP2C19 gene polymorphism on the efficacy of escitalopram in the treatment of depression with anxiety symptoms

目的观察中国中部地区汉族抑郁症伴焦虑症状患者细胞色素P4502C19(CYP2C19)基因多态性的分布特点,探讨CYP2C19基因多态性对艾司西酞普兰治疗抑郁症伴焦虑症状疗效的影响。方法连续招募154例抑郁症伴焦虑症状患者,采用荧光染色原位杂交技术检测CYP2C19基因型。依据CYP2C19基因检测结果,将患者分为快代谢组、中等代谢组和慢代谢组,三组患者均用艾司西酞普兰抗抑郁症伴焦虑症状治疗,连续用药4周,分析三组治疗前后汉密尔顿抑郁量表17项(HAMD-17)、汉密尔顿焦虑量表14项(HAMA-14)评分及治疗后副反应量表(TESS)评分情况,记录三组治疗有效率,二元logistic回归分析治疗效果的影响因素。结果快代谢组、中等代谢组和慢代谢组分别有63例(40.9%)、69例(44.8%)和22例(14.3%)患者。治疗前,三组HAMD-17及HAMA-14评分差异无显著性(P>0.05);治疗后,慢代谢组HAMD-17、HAMA-14评分均显著低于快代谢组和中等代谢组(P<0.05);三组TESS评分差异无显著性(P>0.05);慢代谢组治疗有效率显著高于快代谢组(P<0.05);二元logistic回归分析显示,CYP2C19基因快代谢型患者应用艾司西酞普兰治疗抑郁症伴焦虑症状有效的概率为慢代谢型患者的24.7%(OR=0.247,P=0.010)。结论CYP2C19基因多态性对艾司西酞普兰治疗抑郁症伴焦虑症状的疗效有影响,且慢代谢型患者治疗效果显著优于快代谢型患者。

Objective To observe the distribution of CYP2C19 gene polymorphism in depressive patients with anxiety symptoms in the Han nationality of central China,and to explore the effect of CYP2C19 gene polymorphism on the efficacy of escitalopram in the treatment of depression with anxiety symptoms.Methods 154 depressive patients with anxiety symptoms were recruited continuously and CYP2C19 genotype was detected by fluorescence staining in situ hybridization.Based on the results of CYP2C19 gene detection,the patients were divided into the fast metabolism group,the secondary metabolic group,and the slow metabolism group.All the three groups were treated withescitalopram for 4 weeks.The scores of 17 items of Hamilton Depression Scale(HAMD-17)、14 items of Hamilton Anxiety Scale(HAMA-14)and Treament Emergent Symptoms Scale(TESS)after treatment were analyse.The effective rates of three groups were recorded,and the factors influencing the therapeutic effect were analyzed by binary logistic regression.Results The number and proportion of the fast metabolism group,the secondary metabolic group and the slow metabolism group were 63(40.9%)、69(44.8%)and 22(14.3%),respectively.Before treatment,there was no significant difference in HAMD-17 and HAMA-14 score among the three groups(P>0.05).After treatment,the HAMD-17 and HAMA-14 score of the slow metabolic group was significantly lower than those of the fast metabolicgroup and the medium metabolic group(P<0.05).There was no significant difference in TESS score among the three groups(P>0.05).The effective rate of slow metabolic group was significantly higher than that of fast metabolic group(P<0.05).Binary logistic regression analysis showed that the possibility of effective treatment of depression with anxiety symptoms in patients with rapid CYP2C19 gene was 24.7%of that in patients with slow metabolism(OR=0.247,P=0.010).Conclusions CYP2C19 gene polymorphism has an impact on the efficacy of escitalopram in the treatment of depression with anxiety symptoms,and the treatment effect of patients with slow metabolism is significantly better than that of patients with fast metabolism.