基于药物基因组学的个体化用药对难治性抑郁症的疗效及安全性分析

Efficacy and safety analysis of pharmacogenomics-based personalized medication for treatment-resistant depression

目的探讨基于药物基因组学选药和基于循证医学选药对难治性抑郁症的疗效及安全性的差异。方法选取2021年12月至2022年11月于郴州市第一人民医院就诊的难治性抑郁症患者112例作为研究对象,采用随机数字表法分为基因导向选择抗抑郁药组(观察组,52例)与循证医学导向选择抗抑郁药组(对照组,60例)。观察组用采样刷无创采集口腔黏膜上皮细胞进行抗抑郁药物基因检测。对照组由指定医生根据《中国抑郁障碍防治指南2017年修订版》选择药物。使用17项汉密尔顿抑郁量表(HAMD-17)在基线时及治疗后第4、8周末进行两组抗抑郁治疗疗效评估。使用治疗中需处理的抗抑郁药物不良反应量表在治疗后第4、8周末评定两组不良反应。结果治疗8周后两组有效率比较,差异无统计学意义(χ^(2)=0.218,P=0.897)。两组治疗后第4、8周末HAMD-17减分率观察组均高于对照组,差异均有统计学意义(P<0.05)。重复测量方差分析结果显示,两组HAMD-17评分存在时间效应及交互效应(P<0.05)。与基线时相比,治疗后第4、8周末两组HAMD-17评分均降低,且治疗后第8周末低于治疗后第4周末,差异均有统计学意义(P<0.05)。观察组基线时、治疗后第4周末、治疗后第8周末均低于对照组,差异有统计学意义(P<0.05)。对照组不良反应发生率高于观察组,差异有统计学意义(P<0.05)。结论基因导向选择抗抑郁药在降低HAMD-17评分及减少药物不良反应方面优于循证导向选择抗抑郁药。

Objective To compare the efficacy and safety of drug selection based on pharmacogenomics and evidence-based medicine for treatment-resistant depression.Methods A total of 112 patients with treatment-resistant depression in the First People's Hospital of Chenzhou from December 2021 to November 2022 were selected as the research objects,and were divided into gene-guided selection of antidepressants group(observation group,52 cases)and evidence-based medicine-guided selection of antidepressants group(control group,60 cases)according to random number table method.In observation group,oral mucosal epithelial cells were collected non-invasively by sampling brush for antidepressant gene detection.In control group,drugs were selected by designated doctors according to the Chinese Guidelines for the Prevention and Treatment of Depressive Disorders 2017 Revision.Hamilton Rating Scale for Depression(HAMD-17)was used to evaluate the efficacy of antidepressant treatment at baseline and at the end of 4 and 8 weeks.Side effects were assessed by Treatment-managed Antidepressant Adverse Events scale at the end of 4 and 8 weeks.Results After 8 weeks of treatment,there was no significant difference in the effective rate between the 2 groups(χ^(2)=0.218,P=0.897).The reduction rate of HAMD-17 scores in observation group was higher than that in control group at the end of 4 and 8 weeks after treatment,and the differences were statistically significant(P<0.05).Repeated measures analysis of variance showed that there were time effects and interaction effects in HAMD-17 scores between the 2 groups(P<0.05).Compared with the baseline,the HAMD-17 scores of the 2 groups decreased at the end of 4 and 8 weeks of treatment,and the HAMD-17 scores at the end of 8 weeks of treatment were significantly lower than those at the end of 4 weeks of treatment(P<0.05).The observation group was lower than control group at baseline,4 weeks and 8 weeks of treatment,and the differences were statistically significant(P<0.05).The incidence of adverse reactions in control group was higher than that in observation group,and the difference was statistically significant(P<0.05).Conclusion Gene-directed antidepressant selection is superior to evidence-based antidepressant selection in reducing HAMD-17 score and adverse drug reactions.