药物基因组学检测在难治性精神分裂症患者中的临床效能

兰吴沅; 胡伟明; 兰智勇

doi:10.16766/j.cnki.issn.1674-4152.002854

药物基因组学检测在难治性精神分裂症患者中的临床效能

doi: 10.16766/j.cnki.issn.1674-4152.002854

衢州市第三医院男精神科，浙江衢州 324000

基金项目:

浙江省卫生健康科技计划项目 2022KY1352

详细信息

通讯作者:
胡伟明，E-mail: 523889843@qq.com

中图分类号: R749.3
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出版历程
- 收稿日期: 2022-10-18
- 网络出版日期: 2023-04-20

Clinical efficacy of pharmacogenomic testing in patients with refractory schizophrenia

Department of Male Psychiatry, Quzhou Third Hospital, Quzhou, Zhejiang 324000, China

摘要

摘要: 目的为提升难治性精神分裂症患者用药有效性、安全性，本文重点探讨药物基因组学检测在难治性精神分裂症患者中的应用效果。方法选择2021年11月—2022年9月在衢州市第三医院诊治的难治性精神分裂症男性患者100例纳入研究，依据随机数表法将患者分为对照组(基于医生经验用药)和观察组(基于药物基因检测用药)，每组50例。比较2组临床疗效、自知力、生活质量、出院1个月及1年的社会适应状况、复发率、不良反应发生率。结果治疗1个月后，观察组患者阳性症状、阴性症状、一般精神病理症状评分均低于对照组[(20.11±2.67)分vs. (23.89±3.10)分，(15.02±1.88)分vs. (18.27±2.33)分，(30.35±2.93)分vs. (35.24±3.80)分，均P＜0.001]；观察组自知力评定量表(SAI)与简明健康状况调查问卷(SF-36)评分均明显高于对照组[(10.27±1.71)分vs. (7.24±1.62)分，(88.06±18.37)分vs. (73.41±16.82)分，均P＜0.001]。出院1个月及1年后，观察组个人和社会功能量表(PSP)评分均明显高于对照组[(68.30±6.10)分vs. (59.24±5.68)分，(81.32±7.30)分vs. (75.49±6.29)分，均P＜0.001]；观察组药物相关不良反应发生率明显低于对照组(P＜0.05)。出院1年后，观察组复发率明显低于对照组(P＜0.001)。结论依据药物基因组检测结果指导难治性精神分裂症临床用药优势明显，症状缓解快，可改善患者生活质量、社会适应性，复发率及不良反应率低，值得临床推广应用。
- 难治性精神分裂症 /
- 药物基因组学检测 /
- 自知力评定量表 /
- 简明健康状况调查问卷
Abstract: Objective This study aims to improve the efficacy and safety of drug use in patients with refractory schizophrenia, this paper focuses on the application of pharmacogenomic testing in refractory schizophrenia. Methods A total of 100 male patients with refractory schizophrenia who were diagnosed and treated in Quzhou Third Hospital from November 2021 to September 2022 were included in this study. The patients were divided into control group (based on doctors' experience) and observation group (based on pharmacogenetic testing) according to the random number table method, with 50 cases in each group. The clinical efficacy, insight, quality of life, social adaptation at 1 month and 1 year after discharge, recurrence rate and adverse reaction rate between the two groups were compared. Results After 1 month of treatment, all symptom types (positive, negative, and general psychopathological symptom) in the observation group were lower than those in the control group [(20.11±2.67) points vs. (23.89±3.10) points, (15.02±1.88) points vs. (18.27±2.33) points, (30.35±2.93) points vs. (35.24±3.80) points, all P < 0.001]; the scores of schedule for assessing insight (SAI) and 36 item short form (SF-36) in the observation group were significantly higher than those in the control group [(10.27±1.71) points vs. (7.24±1.62) points, (88.06±18.37) points vs. (73.41±16.82) points, both P < 0.001]. At 1 month and 1 year after discharge, the personal and social functioning scale (PSP)score of the observation group was significantly higher than that of the control group [(68.30±6.10) points vs. (59.24±5.68) points, (81.32±7.30) points vs. (75.49±6.29) points, both P < 0.001]. The incidence of drug-related adverse reactions in the observation group was significantly lower than that in the control group (P < 0.05). One year after discharge, the recurrence rate in the observation group was significantly lower than that in the control group (P < 0.001). Conclusion It has obvious advantages to guide the clinical medication of refractory schizophrenia according to the results of pharmacogenomic testing. Patients not only have high compliance and fast symptom relief, but also can promote the quality of life, social adaptability, reduce the recurrence rate and adverse reaction rate, which is worthy of clinical promotion.
- Refractory schizophrenia /
- Pharmacogenomic assays /
- Schedule for assessing insight /
- 36-item short-form

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表 1 2组难治性精神分裂症患者一般资料比较

Table 1. Comparison of general data in two groups of patients with refractory schizophrenia

组别	例数	年龄 (x±s，岁)	BMI (x±s)	病程 [M(P₂₅, P₇₅)，年]	民族(例)
组别	例数	年龄 (x±s，岁)	BMI (x±s)	病程 [M(P₂₅, P₇₅)，年]	汉族	其他
对照组	50	32.07±11.30	22.38±4.88	10.30(2.33, 18.50)	40	10
观察组	50	33.49±12.07	21.52±5.01	11.25(3.08, 19.68)	42	8
统计量		0.607^a	0.869^a	0.239^b	0.271^c
P值		0.545	0.387	0.782	0.603
注：^a为t值，^b为Z值，^c为χ²值。

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表 2 2组难治性精神分裂症患者PANSS量表评分比较(x±s，分)

Table 2. Comparison of PANSS scale scores in two groups of patients with refractory schizophrenia (x±s)

组别	例数	阳性症状		阴性症状		一般精神病理症状
组别	例数	治疗前	治疗1个月后	治疗前	治疗1个月后	治疗前	治疗1个月后
对照组	50	30.23±3.28	23.89±3.10^a	23.59±2.98	18.27±2.33^a	40.08±3.87	35.24±3.80^a
观察组	50	29.10±3.19	20.11±2.67^a	23.14±3.07	15.02±1.88^a	39.69±4.01	30.35±2.93^a
t值		0.239	6.533	0.744	7.676	0.495	7.206
P值		0.812	＜0.001	0.459	＜0.001	0.622	＜0.001
注：与同组治疗前比较，^aP＜0.05。

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表 3 2组难治性精神分裂症患者生活质量比较(x±s，分)

Table 3. Comparison of quality of life in two groups of patients with refractory schizophrenia (x±s, points)

组别	例数	SAI评分		t值	P值	SF-36评分		t值	P值
组别	例数	治疗前	治疗1个月后	t值	P值	治疗前	治疗1个月后	t值	P值
对照组	50	6.27±1.22	7.24±1.62	3.382	0.001	62.59±15.03	73.41±16.82	3.392	0.001
观察组	50	6.38±1.31	10.27±1.71	12.769	＜0.001	62.71±14.35	88.06±18.37	7.690	＜0.001
t值		0.435	9.096			0.041	4.159
P值		0.665	＜0.001			0.968	＜0.001

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表 4 2组难治性精神分裂症患者治疗前后PSP评分比较(x±s，分)

Table 4. Comparison of PSP scores in two groups of refractory schizophrenia patients before and after treatment (x±s, points)

组别	例数	治疗前	出院1个月	出院1年	F值	P值
对照组	50	46.50±3.07	59.24±5.68^a	75.49±6.29^ab	389.771	＜0.001
观察组	50	45.87±3.16	68.30±6.10^a	81.32±7.30^ab	480.005	＜0.001
t值		1.011	7.686	4.278
P值		0.314	＜0.001	＜0.001
注：与同组治疗前比较，^aP＜0.05；与同组出院1个月比较，^bP＜0.05。

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表 5 2组难治性精神分裂症患者不良反应发生率比较[例(%)]

Table 5. Comparison of the incidence of adverse reactions in two groups of refractory schizophrenia patients [cases (%)]

组别	例数	焦虑	嗜睡	恶心呕吐	体重增加	便秘	合计
对照组	50	2(4.00)	5(10.00)	2(4.00)	1(2.00)	3(6.00)	13(26.00)
观察组	50	0	2(4.00)	0	0	2(4.00)	4(8.00)
注：2组不良反应总发生率比较，χ²=5.741，P=0.017。

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