药物基因组学检测结合治疗药物监测指导抗抑郁药治疗的研究进展

Research progress on guiding antidepressant therapy using pharmacogenomics testing combined with therapeutic drug monitoring in depression treatment

抗抑郁药治疗是抑郁症最主要的治疗方式。传统药物治疗模式下医生靠临床经验评估患者个体差异,缺乏客观参考指标。以药物基因组学检测(pharmacogenomics,PGx)和治疗药物监测(therapeutic drug monitoring,TDM)为代表的药学技术近年来在临床广泛开展,可提供患者在遗传和代谢方面的个体差异信息,现已成为指导精神疾病个体化用药的重要手段。针对抗抑郁药,结合这2种药学技术指导个体化治疗的研究也逐渐增加。本文对抗抑郁药治疗中PGx和TDM相关循证依据、对药物疗效及不良反应的影响,以及PGx和TDM结合使用的影响因素进行回顾和综述,为优化抗抑郁药使用提供参考依据。

Antidepressant therapy is the primary treatment for major depressive disorder.Physicians rely on clinical experience in traditional medication practice to assess individual differences,lacking objective indicators.In recent years,pharmacological technologies represented by pharmacogenomics(PGx)testing and therapeutic drug monitoring(TDM)have been widely implemented in clinical practice.These technologies provide information on patients′genetic and metabolic differences and have become important tools for guiding individualized medication in treating psychiatry disorders.There have been an increasing number of studies combining PGx and TDM to guide individualized antidepressant treatment.This article reviews and summarizes the evidence related to PGx and TDM in antidepressant treatment,their impact on drug efficacy and adverse reactions,and the influencing factors of their combined use,providing a reference for optimizing antidepressants usage.