抑郁症患者免疫相关mRNA表达水平与抗抑郁药物治疗反应的相关性

Correlation between immune-related mRNA expression levels and response to antidepressant therapy in patients with major depressive disorder

目的分析抑郁症(MDD)患者免疫相关mRNA表达水平与抗抑郁药物治疗反应的相关性。方法选取246例MDD患者,于治疗前检测免疫相关mRNA表达水平,给予抗抑郁药物治疗。根据患者应用抗抑郁药物治疗后的反应情况分为不敏感组和对照组。比较两组的临床资料。应用多因素Logistic回归分析相关因素与抗抑郁药物治疗无反应间的关系。结果246例MDD患者中有42例患者应用抗抑郁药物治疗无反应为不敏感组;剩余204例为对照组。药物治疗无反应率为17.07%。不敏感组MMSE评分低于对照组(P<0.01),不敏感组STAT3 mRNA表达量、mTOR mRNA表达量、IL-6和TGF-β均高于对照组(P<0.01)。回归分析结果显示,STAT3 mRNA表达量、mTOR mRNA表达量、IL-6和TGF-β是抗抑郁药物治疗无反应的独立危险因素(P<0.05),MMSE评分是抗抑郁药物治疗无反应的的保护性因素(P<0.01)。ROC曲线显示,mTOR mRNA表达量预测抗抑郁药物治疗无反应的诊断效能高于MMSE评分、STAT3 mRNA表达量、IL-6及TGF-β,其中mTOR mRNA表达量的最佳截点为>0.83,此时敏感性为81.0%,特异性为78.4%。结论MDD患者认知功能和免疫相关mRNA表达水平与应用抗抑郁药物治疗后的反应密切相关,早期监测有助于发现抗抑郁药物治疗不敏感的患者,早期改变治疗方案、提高疗效。

Objective To explore the correlation between immune-related mRNA expression levels and response to antidepressant therapy in patients with major depressive disorder(MDD).Methods A total of 246 patients with MDD were selected and their immune-related mRNA expression levels were detected before treatment.All subjects were divided into insensitive group and control group according to their response to antidepressant therapy.The clinical data of two groups were compared.Multivariate logistic regression was used to analyze the relationship between related factors and non-response to antidepressant therapy.Results Among 246 MDD patients,42 patients showed no response to antidepressant treatment as insensitive group,and the remaining 204 cases were in control group.The unresponsive rate of drug therapy was 17.07%.The total score of MMSE in insensitive group was lower than that in control group(P<0.01),and the levels of STAT3 mRNA,mTOR mRNA,IL-6 and TGF-βin insensitive group were higher than those in control group(P<0.01).Multivariate logistic regression analysis showed that STAT3 mRNA expression level,mTOR mRNA expression level,IL-6 and TGF-βwere independent risk factors for non-response to antidepressant therapy(P<0.05),and MMSE score was a protective factor for non-response to antidepressant therapy(P<0.01).The ROC curve showed that mTOR mRNA expression was more effective than MMSE score,STAT3 mRNA expression,IL-6 and TGF-βin predicting non-response to antidepressant treatment.The optimal cut-off point of mTOR mRNA expression was>0.83,and the sensitivity was 81.0%and the specificity was 78.4%.Conclusion The levels of cognitive function and immune-related mRNA expression in patients with MDD are closely related to the response to antidepressant treatment.Early monitoring is helpful to detect patients who are not sensitive to antidepressant treatment,so as to change the treatment regimen early and improve the efficacy.