Clinical subtypes of premenstrual syndrome and responses to sertraline treatment.
Clinical subtypes of premenstrual syndrome and responses to sertraline treatment.
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DOI：
10.1097/aog.0b013e318236edf2
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发表时间：
2011-12
影响因子：
7.2
通讯作者：
Sondheimer SJ
中科院分区：
文献类型：
--
作者：
Freeman EW;Sammel MD;Lin H;Rickels K;Sondheimer SJ
评估诊断亚型和症状亚型对舍曲林治疗的反应。这是对被诊断为经前综合征(PMS)或经前焦虑症并在三个国立卫生研究院支持的临床试验(N=447)中接受治疗的妇女进行的二次数据分析。根据心理、身体或两种症状类型的优势，确定了三种经前综合征亚型。根据每日症状日记计算每个症状的评分以及基线和终点的经前总评分。根据基线严重程度调整的线性回归模型估计了三个治疗月经周期(或终点，如果更早)后与基线的变化。与安慰剂相比，经前综合症和经前焦虑症的诊断与舍曲林相似，而基于症状的亚型对治疗有不同的反应。与安慰剂相比，混合症状亚型对舍曲林的反应最强(每日症状评分差值33.8，95%CI：17.16，50.44，P<；0.001)，而躯体症状亚型对舍曲林的反应最差(DSR差值9.50，95%CI：−16.29，35.28，P=0.470)。基于临床改善的结果(比基线下降50%)表明，需要8.3名混合症状亚型、3.9名心理亚型和7.1名生理亚型的参与者来观察亚型中将实现临床改善的一名女性。经前综合症和经前焦虑症的诊断对舍曲林治疗的反应相似，但基于症状的亚型对这种治疗的反应显著不同。混合型和心理性症状亚型改善明显，而躯体症状亚型改善不明显。确定患者的主要症状及其严重程度对于个体化治疗和对选择性5-羟色胺再摄取抑制剂的可能反应非常重要。
To estimate response of diagnosis and symptom-based subtypes to sertraline treatment. This was a secondary data analysis for women who were diagnosed with premenstrual syndrome (PMS) or premenstrual dysphoric disorder and treated in three National Institutes of Health-supported clinical trials (N=447). Three PMS subtypes were identified based on predominance of psychological, physical, or both symptom types. Scores for each symptom and a total premenstrual score at baseline and endpoint were calculated from daily symptom diaries. Change from baseline after three treated menstrual cycles (or endpoint if sooner) was estimated using linear regression models adjusted for baseline severity. The PMS and premenstrual dysphoric disorder diagnoses improved similarly with sertraline relative to placebo, while symptom-based subtypes had differential responses to treatment. The mixed symptom subtype had the strongest response to sertraline relative to placebo (Daily Symptom Rating [DSR] difference 33.80, 95% CI: 17.16, 50.44, P<0.001), and the physical symptom subtype had the poorest response to sertraline (DSR difference 9.50, 95% CI: −16.29, 35.28, P=0.470). Results based on clinical improvement (50% decrease from baseline) indicated that 8.3 participants in the mixed symptom subtype, 3.9 in the psychological subtype, and 7.1 in the physical subtype are needed to observe one woman in the subtype who would achieve clinical improvement. The PMS and premenstrual dysphoric disorder diagnoses have similar response to sertraline treatment, but symptom-based subtypes have significantly different responses to this treatment. Mixed and psychological symptom subtypes improved while the physical symptom subtype did not improve significantly. Identifying the patient’s predominant symptoms, and their severity is important for individualized treatment and possible response to a selective serotonin reuptake inhibitor.