基于抗精神病药物基因检测的住院精神分裂症患者临床用药的效果观察

Efficacy observation of clinical medication guided by genetic testing of antipsychotic drugs in patients with schizophrenia

背景抗精神病药物基因检测结果可指导临床合理用药,有助于改善精神分裂症患者的临床症状,但目前国内关于基因检测结果指导抗精神病药物治疗对患者服药依从性、社会功能和药物副反应的影响的证据较薄弱。目的探讨在抗精神病药物基因检测结果指导下用药对精神分裂症患者临床症状、服药依从性和社会功能的改善情况,并考查其药物治疗安全性,为精神分裂症患者的精准治疗提供参考。方法选取2019年7月—2021年8月在达州市民康医院住院治疗、符合《国际疾病分类(第10版)》(ICD-10)诊断标准的急性期精神分裂症患者(n=144)为研究对象。采用随机数字表法分为研究组和对照组各72例。对照组根据医生临床经验接受药物治疗,研究组根据抗精神病药物基因检测结果接受相应的药物治疗。两组均接受12周治疗。于基线期,治疗2、4、8、12周后,采用阳性和阴性症状量表(PANSS)、8项版Morisky服药依从性量表(MMAS-8)、社会功能评定量表(SFRS)和副反应量表(TESS)进行评定。结果两组PANSS、MMAS-8、SFRS评分减分率的时间效应、组间效应均有统计学意义(F时间=95.251、6.650、14.101,P均<0.01,F组间=38.055、58.175、128.221,P均<0.01);两组MMAS-8评分减分率的交互效应有统计学意义(F交互=5.837,P<0.01);两组药物副反应的严重程度评分和病人痛苦程度评分的组间效应和交互效应均有统计学意义(F组间=7.553、81.533,F交互=8.693、9.322,P均<0.01)。结论抗精神病药物基因检测结果指导精神分裂症患者用药在临床症状缓解、服药依从性、社会功能改善和药物副反应方面的效果可能优于临床经验用药。

Background Results of genetic testing for antipsychotic drugs can guide the rational use of drugs in clinical practice and help improve the clinical symptoms of patients with schizophrenia.However,there is currently limited evidence in China regarding the impact of genetic testing results on medication adherence,social function and drug side effects of antipsychotic drug treatment.Objective To explore the improvement of clinical symptoms,medication adherence and social function in patients with schizophrenia under the guidance of antipsychotic drug gene testing results and examine the safety of drug treatment,so as to provide references for ifor precise treatment of schizophrenia patients.Methods Patients with acute schizophrenia who received hospitalization at Dazhou Minkang Hospital from July 2019 to August 2021 as well as met the diagnostic criteria of the International Classification of Diseases,tenth edition(ICD-10)were selected as research subjects(n=144).Based on random number table,subjects were divided into study group and control group,with 72 cases in each group.Control group received drug treatment based on the doctor′s clinical experience,while study group received drug treatment based on the results of gene testing for antipsychotic drug.Both treatments lasted for 12 weeks.At baseline as well as 2,4,8 and 12 weeks after treatment,Positive and Negative Syndrome Scale(PANSS),8-item Morisky Medication Adherence Scale(MMAS-8),Social Functional Rating Scale(SFRS)and Treatment Emergent Symptom Scale(TESS)were adopted for assessment.Result Time effect and group effect of the reducing rate of PANSS,MMAS-8 and SFRS scores in the groups were statistically significant(Ftime=95.251,6.650,14.101,Fgroup=38.055,58.175,128.221,P<0.01).The interaction effect of the reduction rates of MMAS-8 scores in two groups was statistically significant(Finteraction=5.837,P<0.01).The group effect and interaction effect of the severity scores of drug side effects and patient pain scores in two groups were statistically significant(Fgroup=7.553,81.533,Finteraction=8.693,9.322,P<0.01).Conclusion In terms of improving clinical symptom relief,medication adherence,social function and drug side effects,medication for patients with schizophrenia guided by genetic testing of antipsychotic drugs may be more effective than that relying on medication based on clinical experience.