CYP2C19基因多态性对西酞普兰治疗急性心肌梗死后抑郁的影响

目的探讨CYP2C19基因多态性对西酞普兰治疗急性心肌梗死(AMI)后抑郁的影响。方法连续招募137例AMI后抑郁症患者,采用DNA微阵列芯片法检测CYP2C19基因型。依据CYP2C19基因检测结果,将患者分为快代谢组、中等代谢组和慢代谢组,3组患者均在冠心病二级预防的基础之上单用西酞普兰抗抑郁治疗,连续用药6周。记录3组治疗前及治疗后2、4、6周后汉密尔顿抑郁量表17项(HAMD-17)、汉密尔顿焦虑量表14项(HAMA-14)评分及治疗过程中副反应量表(TESS)评分情况,记录3组治疗6周后总有效率,二元Logistic回归分析治疗效果的影响因素。结果快代谢组、中等代谢组和慢代谢组分别有46例(33.6%)、66例(48.2%)和25例(18.2%)患者。治疗前,3组HAMD-17及HAMA-14评分差异无统计学意义(P>0.05);治疗4、6周后3组HAMD-17评分及慢代谢组HAMA-14评分显著低于治疗前,随治疗时间延长逐渐降低,且慢代谢组显著低于快代谢组和中等代谢组(P<0.05);快代谢组和中等代谢组治疗6周后HAMA-14评分显著低于治疗前(P<0.05);治疗过程中,3组TESS评分差异无统计学意义(P>0.05);3组治疗总有效率有显著性差异,且慢代谢组治疗总有效率显著高于快代谢组(P<0.05);二元Logistic回归分析显示,快代谢组患者应用西酞普兰抗抑郁治疗有效可能性为慢代谢组患者的24.3%(OR=0.243,95%CI 0.082~0.721,P=0.011)。结论CYP2C19基因多态性对AMI患者应用西酞普兰抗抑郁治疗有影响,且慢代谢型患者治疗效果优于快代谢型。

Effect of CYP2C19 gene polymorphism on citalopram in the treatment of depression after acute myocardial infarction

Objective To investigate the effect of CYP2C19 gene polymorphism on citalopram in the treatment of depression after acute myocardial infarction(AMI).Methods 137 patients with depression after AMI were recruited continuously and CYP2C19 genotype was detected by DNA microarray chip method.According to the results of CYP2C19 gene detection,the patients were divided into the fast metabolism group,the secondary metabolic group,and the slow metabolism group.On the basis of secondary prevention of coronary heart disease,the three groups used citalopram alone antidepressant treatment for 6weeks.The scores of Hamilton Depression Scale 17(HAMD-17),Hamilton Anxiety Scale 14(HAMA-14)before and 2,4 and 6 weeks after treatment and Treament Emergent Symptoms Scale(TESS)during treatment were recorded.The total effective rate of the three groups after 6 weeks was recorded,and the influencing factors of the therapeutic effect were analyzed by binary logistic regression.Results The number and proportion of the fast metabolism group,the secondary metabolic group and the slow metabolism group were 46(33.6%),66(48.2%)and 25(18.2%),respectively.Before treatment,there was no significant difference in HAMD-17 and HAMA-14 score among the three groups(P>0.05);The scores of HAMD-17 in the three groups and HAMA-14 score of the slow metabolic group after 4 and 6 weeks were significantly lower than those before treatment,and gradually decreased with the prolongation of treatment time,and the scores in the slow metabolic group were significantly lower than those in the fast metabolic group and the medium metabolic group(P<0.05).During the treatment,there was no significant difference in TESS scores among the three groups(P>0.05).The total effective rate of the three groups was significantly different,and the total effective rate of the slow metabolic group was significantly higher than that of the fast metabolic group(P<0.05).Bivariate Logistic regression analysis showed that the possibility of effective antidepressant therapy in fast metabolism group is 24.3%of the slow metabolism group(OR=0.243,95%CI is 0.082-0.721,P=0.011).Conclusion CYP2C19 gene polymorphism has influence on the antidepressant treatment of citalopram in AMI patients,and the treatment effect of slow metabolism patients is better than that of fast metabolism patients.