Response of schizophrenia patients with different intestinal flora distribution to olanzapine
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摘要:
目的 探究首诊精神分裂症患者的肠道菌群分布以及不同肠道菌群分布患者对于奥氮平的反应性。 方法 选择2020年3月—2021年1月于衢州市第三人民医院精神科首次诊断和治疗的精神分裂症患者40例作为研究对象，采用16S rRNA测序以及基因数据库检测其肠道菌群分布，根据结果进行分组。采用奥氮平规律治疗8周，比较不同菌群分布的精神分裂症患者治疗效果、阳性与阴性症状量表(PANSS)评分、个人与社会表现量表(PSP)评分的差异。 结果 40例患者中，1型肠道菌群分布共9例，以普雷沃菌属为主；2型共31例，以拟杆菌属、布劳特氏菌属、粪厌氧棒杆菌、孪生菌为主。治疗8周后，1型菌群分布患者的治疗显效率、有效率和无效率分别为55.56%、44.44%、0.00%，2型菌群上述指标分别为19.35%、54.85%、25.81%，差异有统计学意义(Z=2.531，P < 0.05)。1型肠道菌群分布的患者PANSS评分低于2型(t=4.261，P < 0.05)，PSP评分高于2型(t=5.921，P < 0.05)。 结论 肠道菌群以普雷沃菌属为主的精神分裂症患者对奥氮平的反应性更佳，更有利于改善症状和个人与社会表现，根据肠道菌群判断患者预后成为一种潜在的方式。 Abstract:Objective To explore the distribution of intestinal flora in patients with schizophrenia and the response of patients with different intestinal flora to olanzapine. Methods From March 2020 to January 2021, 40 schizophrenic patients who were diagnosed and treated in our hospital for the first time were selected as the research objects. 16S rRNA sequencing and gene database were used to detect the distribution of intestinal flora. According to the results, the patients were divided into groups and treated with olanzapine for 8 weeks. The scores of the positive and negative syndrome scale (PANSS), personal and social performance scale (PSP) and Wisconsin Card Sorting Test were compared. Results In 40 patients, 9 cases had type 1 flora (mainly Prevotella), and 31 cases had type 2 flora (mainly Bacteroides, Brucella, Anaerostipes and Eggerthella). After 8 weeks of treatment, the significant efficiency, effective rate and ineffective rate of treatment of patients with type 1 flora distribution were 55.56%, 44.44% and 0.00%, respectively, and those of patients with type 2 flora distribution were 19.35%, 54.85% and 25.81%, respectively. The difference was statistically significant (Z=2.531, P < 0.05). The PANSS score of patients with type 1 intestinal flora distribution was lower than that of patients with type 2 intestinal flora distribution (t=4.261, P < 0.05), and the PSP score was higher in the former than in the latter (t=5.921, P < 0.05). Conclusion Schizophrenic patients with type 1 intestinal flora distribution have better response to olanzapine, which is more conducive to improving symptoms and personal and social performance. Therefore, the prognosis of patients can be determined according to their intestinal flora. -
Key words:
- Schizophrenia /
- Intestinal flora /
- Olanzapine /
- Drug reactivity /
- Curative effect
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表 1 不同类型肠道菌群分布的相对富集度比较
肠道菌属 相对丰度(%) FDR校正P值 1型 2型 普雷沃菌属 45.50(42.50~49.50) 0.75(0.50~1.00) < 0.001 拟杆菌属 7.60(6.00~9.20) 25.50(14.83~30.62) < 0.001 布劳特氏菌属 2.56(1.54~4.73) 6.05(5.50~7.55) 0.008 粪厌氧棒杆菌 0.09(0.02~0.18) 0.19(0.11~0.25) 0.042 孪生菌 0.03(0.01~0.05) 0.12(0.08~0.17) 0.032 
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表 2 2组精神分裂症患者疗效比较[例(%)]
菌属 例数 显效 有效 无效 1型 9 5(55.56) 4(44.44) 0(0.00) 2型 31 6(19.35) 17(54.84) 8(25.81) 注：2组疗效比较，Z=2.531，P=0.019。
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表 3 2组精神分裂症患者治疗前后PANSS评分及PSP评分比较(x ±s，分)
菌属 例数 PANSS PSP 治疗前 治疗8周后 治疗前 治疗8周后 1型 9 76.58±7.68 38.36±4.30 45.47±3.47 65.48±6.58 2型 31 77.04±7.47 45.85±4.73 45.78±3.50 52.38±5.63 t值 0.162 4.261 0.234 5.921 P值 0.872 < 0.001 0.816 < 0.001
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