抗抑郁剂疗效的预测因素分析

目的:探索影响抑郁症患者抗抑郁剂疗效的预测因素。方法:241例抑郁症患者给予抗抑郁药治疗6周,治疗前后进行汉密顿抑郁量表17项(HAMD)评分,采用减分率评定疗效。分析人口学因素、基线HAMD、明尼苏达多项人格测定(MMPI-2)、认知功能评分及脑源性神经营养因子(BDNF)、5-羟色胺转运体(5-HTTLPR)和糖皮质激素受体(GR)3种基因多态对疗效的预测。结果:基线HAMD评分(β=0.771,P0.001)、MMPI-2中偏执(Pa)分(β=-0.322,P=0.032,R2=0.451)、连线测验B评分(TMT-B)(β=-0.045,P=0.013)、汉诺塔总分(β=-0.067,P=0.026)、数字广度(倒序)分(β=-0.974,P=0.025)及GR BclI基因G-等位基因携带者(P=0.05)与抗抑郁剂HAMD减分率有关。整合模型回归分析显示,结合基线HAMD评分(β=0.894,P0.001)、MMPI-2-Pa分(β=-0.155,P=0.036)和TMT-B分(β=-0.038,P=0.034)3个预测因子可解释57.1%的变异。结论:基线HAMD评分、MMPI-2-Pa分和TMT-B分可预测抗抑郁剂的疗效。

Analysis of predictor factors of antidepressant efficacy

Objective： To explore the predictors factors of antidepressant efficacy in patients with major depressive disorder （MDD）. Method： Two hundred and forty-one MDD patients were treated with anti depreessants for 6 weeks, and were evaluated with 17-item Hamilton rating scale for depression（HAMD） at baseline and after treatment,the rates of decrease in HAMD scores from baseline to 6 weeks after treatment was used to measure the antidepressant treatment efficacy. Predict analysis for the efficacy of antidepressant were analyzed by demographic variables, baseline HAMD scores, Minnesota muhiphasic personality inventory-（ MMPI- 2） scores, neumcognitive performances and seven polymorphisms of brain derived neurophic factor（ BDNF）, 5- hydroxy tryptamine transporter-linked polymorphic region （5-HTTLPR） and glucocorticoid receptor（GR） genes. Results： HAMD scores at baseline （β = 0. 771, P 〈 0. 001 ）, MMPI-2 subscale paranoia （β = - 0. 322, P = 0.032,R2 =0.451 ） ,performance on trail making test-part B（TMT-B） （β = -0.045 ,P =0.013） ,tower of Ha- noi（TOH） （β = - 0.067, P = 0. 026）, digit backward （β = - 0. 974, P = 0.025 ） and G-allele of glucocorticoid receptor gene BclI polymorphism carriers （P = 0.05 ） were associated with the efficacy of antidepressant in treatment of patients with major depressive disorder. The integrate regression model showed that three predictors,combination of HAMD scores at baseline （β = 0. 894, P 〈 0.001 ）, MMPI-2 subscale paranoia （β = -0. 155 ,P = 0. 036） and TMT-B test （β = - 0. 038, P = 0. 034）, explained 57. 1% of the variance. Conclusion：HAMD scores at baseline, MMPI-2 subscale paranoia and TMT-B test, may serve as predictors of antidepressant treatment outcome.