摘要
目的探讨首发精神分裂症患者应用药物基因检测个性化干预的临床效能。方法选取120例首发精神分裂症患者,随机分为对照组和研究组,各60例,对照组给予医生经验用药,研究组给予药物基因检测用药,评估比较两组临床疗效、安全性及医疗成本。结果治疗后第6个月末,两组阳性与阴性症状量表(PANSS)评分较治疗前降低(P<0.05),个人和社会功能量表(PSP)、简易精神状况检查量表(MMSE)评分较治疗前升高(P<0.05);且研究组PANSS评分低于对照组(P<0.001),PSP及MMSE评分高于对照组(P<0.001)。研究组TESS评分及不良反应发生率均低于对照组(P<0.05)。药物基因5-HTR1A以突变纯合型TT为主、5-HTR2C以突变纯合型GG为主,DRD2以突变杂合型CT为主,MC4R以野生纯合型CC为主。药物基因代谢表型中CYP2D6为中间代谢型、超快代谢型2种,CYP1A2为超快代谢型和广泛代谢型2种,CYP3A4基因全为广泛代谢型。研究组药品成本及住院费用均低于对照组(P<0.01)。结论通过药物基因检测个性化干预可明确患者病况,有效指导首发精神分裂症患者临床治疗,安全性较高,并可降低患者医疗成本,减轻患者经济压力。
Objective To explore the clinical efficacy of applying pharmacogenetic testing personalised intervention in patients with first-episode schizophrenia.Methods A total of 120 patients with first-episode schizophrenia were selected and randomly divided into control group(60 cases)given medication by doctors’experience and study group(60 cases)given medication by pharmacogenetic testing.Clinical efficacy,safety and medical cost were assessed and compared between two groups.Results At the end of the 6 th month after treatment,both groups showed decreased Positive and Negative Syndrome Scale(PANSS)score,and increased scores of Personal and Social Performance Scale(PSP)and Mini-Mental State Examination(MMSE)(P<0.05).Study group showed lower PANSS score and higher scores of PSP and MMSE than control group(P<0.001).The study group showed lower Treatment Emergent Symptom Scale(TESS)score and lower rate of adverse reactions during treatment than control group(P<0.05).The drug genes 5-HTR1A were dominated by mutant pure TT,5-HTR2C by mutant pure GG,DRD2 by mutant heterozygous CT,and MC4R by wild pure CC.The drug gene metabolic phenotypes of CYP2D6 were intermediate metabolism and ultrafast metabolism,CYP1A2 were ultrafast metabolism and extensive metabolism,and all of the CYP3A4 genes were extensive metabolism.Medical cost and hospitalisation cost were lower in study group than those in control group(P<0.01).Conclusion Personalised intervention through pharmacogenetic testing can clarify the patients’disease conditions,effectively guide the clinical treatment of patients with first-episode schizophrenia,with a high degree of safety,and can reduce the patients’medical costs and alleviate their economic pressure.
作者
李腾
赵蕊
韩荦杰
刘海港
贺娜
LI Teng;ZHAO Rui;HAN Luojie(Kailuan General Hospital,Tangshan 063000,China)
出处
《精神医学杂志》
2024年第5期501-505,共5页
Journal of Psychiatry
基金
2024年度河北省医学科学研究课题计划(编号:20241260)。
关键词
首发精神分裂症
药物基因检测
个性化用药
First-episode schizophrenia
Pharmacogenetic testing
Personalised medication
作者简介
通讯作者:贺娜,E-mail:15932080856@163.com。
