Possibility of pharmacogenetic approach suicide prevention in pediatoric major depressive disorder treatment.

对127例患者进行筛查，根据Zung抑郁自评量表(SDS)40分及以上和《精神障碍诊断与统计手册》第四版文本修订版(DSM-IV-TR)筛选出43例有抑郁倾向的患者(男16例，女27例；平均年龄14.3岁；标准差[SD]1.3岁)。抑郁障碍的诊断是由两名评分者确定的，其中包括有执照的儿科心理临床医生，使用结构化临床访谈。健康受试者100例，年龄23~68岁。两组均进行了5-HTTLPR和BDNF基因分型。5-HTTLPR变异频率在对照组中：S等位基因(sl和ss)占98%，BDNFVal66Met等位基因占67%。患者组中5-HTTLPR变异频率为：S等位基因(sl和ss)占94%，BDNFVal66Met等位基因占70%。5-HTTLPR(χ^2检验，p=0.2)和脑源性神经营养因子变异体(χ^2检验，p=0.76)频率在对照组和患者组之间差异无统计学意义。患者随机分为帕罗西汀20 mg/d和氟伏沙明25 mg/d，疗程6周。治疗6周后，采用Zung抑郁自评量表对所有患者进行评定。在治疗6周后，抑郁评分下降至少10%的患者被定义为有效者。应答组和无应答组的5-HTTLPR基因频率差异无统计学意义(χ^2检验，p=0.33)。应答组和无应答组的脑源性神经营养因子基因频率无显著差异(χ^2检验，p=0.8)。由于样本量较小，需要进一步采集样本。此外，考虑到5-HTTLPE是多等位基因，使用的SSRI分为帕罗西汀和氟伏沙明，本研究没有考虑性别，还需要进一步分析。

Screenings were conducted on 127 patients, and 43 patients (16boys and 27 girls ; mean age, 14.3 years ; standard deviation [SD], 1.3years) who have shown predisposition for depression were selected based on a Zung self-rating depression scale (SDS) of 40 points or above and Diagnostic and Statistical Manual of Mental Disorders Fourth Edition, Text Revision (DSM-IV-TR). The diagnosis of Depressive disorder was established by two raters including Licensed pediatric-psychological clinician using the Structured Clinical Interview. One hundred healthy subjects (23-68 years) were used as control in the study. Both groups were genotyped for 5-HTTLPR and BDNF. The frequency of the 5-HTTLPR variant was described as below : S allele (sl and ss genotype) was 98% , and for BDNF Val66Met was 67% in the control group. The frequency of the 5-HTTLPR variant was described as below : S allele (sl and ss genotype) was 94% , and for BDNF Val66Met was 70% in the patient group. No significant difference for the frequency of the 5-HTTLPR(χ^2test,p=0.20) and BDNF variants (χ^2test,p=0.76)was found between the control group and the patient group. The patients were randomly assigned to either paroxetine20mg/day or fuluvoxamin25mg/day for 6weeks. All patients were evaluated initially and at weeks 6 using Zung self-rating depression scale (SDS). Patients who showed a minimum of 10% decrease in the SDS score after 6 weeks of treatment were defined as a responder. The frequencies of the 5-HTTLPR genotypes did not significantly differ between the responder and in the non-responder group(χ^2test, p=0.33). The frequencies of the BDNF genotypes did not significantly differ between the responders and in the non-responders(χ^2test,p=0.8). Since the sample size is small, further sample collection is needed. Moreover, considering 5-HTTLPE is multi-allelic, the SSRI used are divided into paroxetine and fuluvoxamin, and gender is not considered in this study, further analysis is needed.