本文選題：驚恐障礙 + CYP2C19　； 參考：《天津醫(yī)科大學》2017年碩士論文

【摘要】：目的:本課題旨在探討驚恐障礙患者CYP2C19基因多態(tài)性與艾司西酞普蘭治療臨床療效間的關聯(lián)。方法:嚴格依照DSM-V診斷標準,選取滿足條件的驚恐障礙患者,選取與之性別、年齡、學歷相匹配的正常對照作為研究對象。選用PDSS-CV、HAMA-14量表在基線、治療2周、治療4周和8周評定臨床癥狀。入組后的患者均服用艾司西酞普蘭10mg/qd治療,研究的8周內(nèi)不得服用其他抗抑郁劑,不使用苯二氮卓類如羅拉等,不使用氯硝西泮、硝基西泮等藥物。抽取入組患者外周靜脈全血,提取基因組DNA,用人類CYP2C19基因多態(tài)性檢測試劑盒(PCR-熒光探針法)檢測CYP2C19基因636、681兩個位點的基因多態(tài)性。運用SPSS17.0統(tǒng)計軟件包進行數(shù)據(jù)分析。結果:1病例組與對照組人口統(tǒng)計學資料分布差異無統(tǒng)計學意義。說明病例組與對照組性別、年齡、婚姻、教育程度、職業(yè)、長期居住地、吸煙、飲酒相匹配。2病例組與對照組CYP2C19基因型和代謝型的頻率分布比較,差異無統(tǒng)計學意義(P0.05)。3比較病例組患者不同代謝型間的一般資料,病例組CYP2C19酶的EM、IM、PM三種代謝型在性別、年齡、婚姻、教育程度、職業(yè)、長期居住地、吸煙、飲酒的分布差異無統(tǒng)計學意義(P0.05)。4比較CYP2C19不同代謝型患者艾司西酞普蘭治療不同治療階段的PDSS-CV量表減分率,在治療第四周和第八周時,三種代謝型PDSS-CV量表減分率有統(tǒng)計學差異(P0.05),每種代謝型治療后比治療前PDSS-CV量表評分有統(tǒng)計學差異(P0.05)。5比較CYP2C19不同代謝型患者艾司西酞普蘭治療不同治療階段的HAMA-14量表減分率,在治療第四周和第八周時,三種代謝型HAMA-14量表減分率有統(tǒng)計學差異(P0.05),每種代謝型治療后比治療前HAMA-14量表評分有統(tǒng)計學差異(P0.05)。6以PD患者在艾司西酞普蘭不同治療階段以PDSS-CV量表減分率≥40%為驚恐癥治療有效。以HAMA-14量表減分率≥50%為焦慮癥狀治療有效。CYP2C19三種代謝型在不同治療階段DSS-CV與HAMA-14量表治療有效數(shù)均在第二周第四周有統(tǒng)計學差異(P0.05)。7認知功能學習-記憶能力中的HVLTR總分與PDSS-CV基線總分存在顯著相關性(P0.05)。8處理速度中的符號編碼評分與HAMA-14 2w評分存在相關性(P0.05)。9驚恐障礙患者的認知功能與STAI量表基線總分、PHQ9量表基線總分等未發(fā)現(xiàn)存在顯著相關性(P0.05)。結論:1在艾司西酞普蘭治療第四周和第八周時,慢代謝型的病人減分率比其他代謝型減分率高,說明攜帶慢代謝型的病人在第四和第八周驚恐癥狀改善更好。2在艾司西酞普蘭治療第四周和第八周時,慢代謝型的病人減分率比其他代謝型減分率高,說明攜帶慢代謝型的病人在第四和第八周焦慮癥狀改善更好。3以PD患者在艾司西酞普蘭不同治療階段以PDSS-CV量表減分率≥40%為驚恐癥治療有效。以HAMA-14量表減分率≥50%為焦慮癥狀治療有效。CYP2C19三種代謝型在不同治療階段DSS-CV與HAMA-14量表治療有效數(shù)均在第二周第四周,慢代謝型病人早期起效率比其他代謝型比率高。4三種代謝型驚恐癥狀和焦慮癥狀與基線比都有所改善。5病例組CYP2C19酶的EM、IM、PM三種代謝型的性別、年齡、婚姻、教育程度、職業(yè)、長期居住地、吸煙、飲酒與艾司西酞普蘭治療臨床療效無關。6病例組與對照組人口統(tǒng)計學資料分布差異無統(tǒng)計學意義。說明性別、年齡、婚姻、教育程度、職業(yè)、長期居住地、吸煙、飲酒與驚恐障礙發(fā)生無關。7病例組的CYP2C19基因型和代謝型的頻率分布與對照組無明顯差異。8認知功能學習-記憶能力中的霍普金斯語言學習測驗總分與驚恐障礙基線嚴重程度存在相關性。9認知功能處理速度中的符號編碼評分與第二周的焦慮癥狀存在相關性。10沒有發(fā)現(xiàn)認知功能與基線狀態(tài)特質(zhì)焦慮、抑郁癥狀及生活質(zhì)量等存在相關性。
[Abstract]:Objective: To explore the relationship between the polymorphism of CYP2C19 gene and the clinical efficacy of Ai Sciplan in the patients with panic disorder. Methods: strictly according to the criteria of DSM-V diagnosis, select the patients with the condition of panic disorder, select the normal controls that match the sex, age, and educational background. Select the PDSS-CV, HAMA-14 scale At baseline, 2 weeks of treatment, treatment for 4 and 8 weeks, the clinical symptoms were evaluated. The patients after the group were treated with Ai Sciplan 10mg/qd, and no other antidepressants were taken in the study for 8 weeks, no use of benzene two azo like Rolla, and no clonazepam, nitrosiazepam and other drugs. The whole blood of the peripheral vein was extracted and extracted from the group of DNA. CYP2C19 gene polymorphism detection kit (PCR- fluorescence probe) was used to detect the gene polymorphism of 636681 CYP2C19 loci in two loci. The data were analyzed by SPSS17.0 software package. The results showed that there was no statistical difference between the 1 case group and the control group. The results showed that the sex, age, marriage of the case group and the control group were in marriage. Marriage, education, occupation, long-term residence, smoking, drinking and matching.2 case group with the control group CYP2C19 genotype and metabolic frequency distribution, the difference was not statistically significant (P0.05).3 compared with the case group patients with different metabolic type general data, the case group CYP2C19 enzyme EM, IM, PM three metabolic types in sex, age, marriage, education. Degree, occupation, long-term residence, smoking and drinking, there was no significant difference in distribution (P0.05).4 compared with the PDSS-CV scale reduction rate of different metabolic patients Ai Sciplan treated at different treatment stages, and at the fourth and eighth weeks of treatment, the reduction rate of the three metabolic PDSS-CV scales was statistically different (P0.05), each type of metabolic type. After treatment, there was a statistical difference compared with the PDSS-CV scale before treatment (P0.05).5 compared to the HAMA-14 scale reduction rate of different metabolic patients with different metabolic types by Ai Sciplan, and at the fourth and eighth weeks of treatment, the reduction rate of the three metabolic HAMA-14 scales had a systematic difference (P0.05), and each metabolic therapy was compared to the treatment after treatment. The scores of the former HAMA-14 scale were statistically different (P0.05).6 for PD patients in the different stages of the treatment of alcitalopram with the PDSS-CV scale subtraction rate of more than 40% for the treatment of panic disorder. The reduction rate of the HAMA-14 scale was more than 50% for the anxiety symptoms and the effective.CYP2C19 three metabolic types were treated with DSS-CV and HAMA-14 at different stages of treatment. There was statistical difference between second weeks (P0.05).7 cognitive function learning - memory ability, there was significant correlation between HVLTR total score and PDSS-CV baseline total score (P0.05) the symbol coding score in.8 processing speed and HAMA-14 2W score had correlation (P0.05).9 panic disorder patients' cognitive function and STAI scale baseline total score, PHQ9 scale base No significant correlation was found in total line score (P0.05). Conclusion: 1 in the four weeks and eighth weeks of escitalopram treatment, the rate of subtraction in slow metabolic patients is higher than that of other metabolic type, indicating that the patients with slow metabolic type improve the panic symptoms in fourth and eighth weeks and better.2 in the four weeks and eighth weeks of the treatment of escitalopram. In patients with slow metabolic type, the rate of subtraction was higher than that of other metabolic type, indicating that the anxiety symptoms improved in the fourth and eighth weeks of the patients with the slow metabolic type were better.3 and the reduction rate of the PDSS-CV scale was more than 40% for the PD patients at different stages of esmolitalopram treatment. The reduction rate of the HAMA-14 scale was more than 50% for the anxiety symptoms. The effective number of effective.CYP2C19 three metabolic types at different stages of DSS-CV and HAMA-14 was second weeks. The early efficiency of the slow metabolic patients was higher than that of other metabolic types,.4 three kinds of metabolic panic symptoms and anxiety symptoms and baseline ratio both improved the EM, IM, PM and three metabolic types of the CYP2C19 enzyme in the.5 case group. Gender, age, marriage, education, occupation, long-term residence, smoking, drinking and the clinical efficacy of Ai Sciplan were not statistically significant differences in the distribution of demographic data between the.6 case group and the control group. It showed that sex, age, marriage, education, vocational, long-term residence, smoking, drinking and panic disorder were not related to.7's disease. There was no significant difference in the frequency distribution of CYP2C19 genotype and metabolic type between the control group and the control group. There was a correlation between the total score of Hopki language learning test in.8 cognitive function learning memory ability and the baseline severity of panic disorder. The symbol coding score of.9 cognitive function processing was associated with the correlation of second weeks of anxiety symptoms,.10 No correlation was found between cognitive function and baseline state trait anxiety, depressive symptoms and quality of life.
【學位授予單位】：天津醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R749.7

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本文編號：1990859