{"id":5512,"date":"2023-12-13T11:56:24","date_gmt":"2023-12-13T16:56:24","guid":{"rendered":"https:\/\/curesz.org\/?page_id=5512"},"modified":"2023-12-15T11:32:51","modified_gmt":"2023-12-15T16:32:51","slug":"issues-with-pharmacogenetic-testing-to-optimize-antipsychotic-therapy","status":"publish","type":"page","link":"https:\/\/curesz.org\/zh\/issues-with-pharmacogenetic-testing-to-optimize-antipsychotic-therapy\/","title":{"rendered":"\u4f18\u5316\u6297\u7cbe\u795e\u75c5\u836f\u7269\u6cbb\u7597\u7684\u836f\u7269\u57fa\u56e0\u7ec4\u5b66\u68c0\u6d4b\u9762\u4e34\u7684\u95ee\u9898"},"content":{"rendered":"

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5) \u76ee\u524d\u5c1a\u65e0\u4efb\u4f55\u57fa\u56e0\u68c0\u6d4b\u6216\u5f71\u50cf\u5b66\u68c0\u67e5\u80fd\u591f\u9884\u6d4b\u60a3\u8005\u5bf9\u6297\u7cbe\u795e\u75c5\u836f\u7269\u7684\u603b\u4f53\u53cd\u5e94\uff0c\u4e5f\u65e0\u6cd5\u9884\u6d4b\u5bf9\u7279\u5b9a\u836f\u7269\u7684\u53cd\u5e94\u3002.<\/strong><\/p>\n

\u591a\u79cd\u95ee\u9898\u7684\u4ea4\u7ec7\u6216\u8bb8\u53ef\u4ee5\u89e3\u91ca\u4e3a\u4ec0\u4e48\u6ca1\u6709\u7814\u7a76\u53d1\u73b0\u4f7f\u7528\u5546\u4e1a\u57fa\u56e0\u68c0\u6d4b\u80fd\u663e\u8457\u6539\u5584\u7cbe\u795e\u5206\u88c2\u75c7\u60a3\u8005\u7684\u9884\u540e\uff0c\u4f46\u8fd9\u786e\u5b9e\u89e3\u91ca\u4e86\u4e3a\u4ec0\u4e48\u4eba\u4eec\u91cd\u65b0\u5bf9\u76f4\u63a5\u6d4b\u91cf\u6297\u7cbe\u795e\u75c5\u836f\u7269\u6d53\u5ea6\u4ea7\u751f\u4e86\u5174\u8da3\uff0c\u4ee5\u4fbf\u51c6\u786e\u91cf\u5316\u4e0d\u4f9d\u4ece\u6027\u3001\u57fa\u56e0\u53d8\u5f02\u3001\u5176\u4ed6\u836f\u7269\u3001\u8865\u5145\u5242\u548c\u5438\u70df\u7b49\u72ec\u7acb\u56e0\u7d20\u7684\u603b\u548c\u6548\u5e94\uff0c\u662f\u5982\u4f55\u5f71\u54cd\u7279\u5b9a\u836f\u7269\u7684\u6e05\u9664\u7387\u4ee5\u53ca\u60a3\u8005\u662f\u5426\u6309\u5904\u65b9\u670d\u836f\u7684\u3002.8,9<\/sup><\/p>\n

\u6c2f\u6c2e\u5e73\u662f\u57fa\u56e0\u68c0\u6d4b\u5e94\u7528\u6240\u53d7\u5c40\u9650\u6027\u7684\u4e00\u4e2a\u91cd\u8981\u4f8b\u8bc1\u3002 \u6c2f\u6c2e\u5e73\u662f\u552f\u4e00\u5bf9\u96be\u6cbb\u6027\u7cbe\u795e\u5206\u88c2\u75c7\u60a3\u8005\u6709\u6548\u7684\u836f\u7269\uff0c\u4f46\u5176\u4ee3\u8c22\u8fc7\u7a0b\u8f83\u4e3a\u590d\u6742\uff0c\u4e00\u9879\u7814\u7a76\u663e\u793a\uff0cCYP 1A2\u30012C19\u30013A4\u30012C9 \u548c 2D6 \u7684\u5e73\u5747\u8d21\u732e\u7387\u5206\u522b\u4e3a 30%\u3001 24%\u300122%\u300112%\u548c6%\u3002.10<\/sup> CYP1A2 \u5bf9\u5438\u70df\u7684\u5f71\u54cd\u975e\u5e38\u654f\u611f\uff0c\u5438\u70df\u8005\u901a\u5e38\u9700\u8981\u6bd4\u975e\u5438\u70df\u8005\u9ad8\u51fa 50% \u7684\u5242\u91cf\u624d\u80fd\u8fbe\u5230\u76f8\u540c\u7684\u6c2f\u6c2e\u5e73\u8840\u836f\u6d53\u5ea6\u3002.11<\/sup> \u53ea\u6709\u5728\u4e34\u5e8a\u533b\u5e08\u5f00\u5177\u6c2f\u6c2e\u5e73\u8840\u836f\u6d53\u5ea6\u68c0\u6d4b\u7684\u60c5\u51b5\u4e0b\uff0c\u624d\u80fd\u89c2\u5bdf\u5230\u8fd9\u79cd\u6548\u5e94\u7684\u5927\u5c0f\u3002\u91cd\u8981\u7684\u662f\uff0c\u9274\u4e8e\u5176\u4e2d\u8bb8\u591aCYP\u9176\u5b58\u5728\u4eba\u7fa4\u53d8\u5f02\uff0c\u4e14\u5f88\u5927\u4e00\u90e8\u5206\u7cbe\u795e\u5206\u88c2\u75c7\u60a3\u8005\u786e\u5b9e\u5438\u70df\uff0c\u8fd1\u671f\u7684\u5efa\u8bae\u91cd\u70b9\u5728\u4e8e\u6839\u636e\u60a3\u8005\u7684\u8840\u7edf\u548c\u5438\u70df\u4e60\u60ef\u6765\u91cf\u8eab\u5b9a\u5236\u6c2f\u6c2e\u5e73\u7684\u65e9\u671f\u7ed9\u836f\u5242\u91cf\uff0c\u4ee5\u907f\u514d\u5728\u6cbb\u7597\u521d\u671f\u51fa\u73b0\u4e0d\u5fc5\u8981\u7684\u9ad8\u8840\u836f\u6d53\u5ea6\uff0c\u968f\u540e\u901a\u8fc7\u68c0\u6d4b\u8840\u836f\u6d53\u5ea6\u6765\u786e\u5b9a\u6240\u6709\u8fd9\u4e9b\u56e0\u7d20\u7684\u7efc\u5408\u6548\u5e94\u3002 \u9488\u5bf9\u8be5\u60a3\u8005<\/em><\/strong>. <\/em>\u4f7f\u60c5\u51b5\u66f4\u52a0\u590d\u6742\u7684\u662f\uff0c\u6c2f\u6c2e\u5e73\u6709\u4e00\u79cd\u6d3b\u6027\u4ee3\u8c22\u7269\u2014\u2014\u53bb\u7532\u6c2f\u6c2e\u5e73\uff0c\u517683%\u7684\u6e05\u9664\u7387\u5e76\u4e0d\u4f9d\u8d56\u4e8eCYP\uff0c\u800c\u662f\u4f9d\u8d56\u4e8e\u4e00\u79cd\u540d\u4e3aP-\u7cd6\u86cb\u767d\uff08PGP\uff09\u7684\u80be\u810f\u836f\u7269\u8f6c\u8fd0\u4f53\u3002.12,13<\/sup> \u6beb\u4e0d\u5947\u602a\uff0cPGP\u7684\u8868\u8fbe\u548c\u529f\u80fd\u4e0eCYPs\u4e00\u6837\uff0c\u90fd\u8868\u73b0\u51fa\u79cd\u7fa4\u95f4\u7684\u53d8\u5f02\uff0c,14<\/sup> \u8fd9\u79cd\u53d8\u5f02\u6027\u4ee3\u8868\u4e86\u53bb\u7532\u57fa\u6c2f\u6c2e\u5e73\u6e05\u9664\u7387\u7684\u4e00\u4e2a\u65b9\u9762\uff0c\u800c\u8bb8\u591a\u5546\u4e1a\u57fa\u56e0\u68c0\u6d4b\u5e76\u672a\u6db5\u76d6\u8fd9\u4e00\u65b9\u9762\u3002.15-17<\/sup><\/p>\n

\u7cbe\u795e\u79d1\u836f\u7269\u57fa\u56e0\u7ec4\u5b66 (PGx) \u68c0\u6d4b\u5b58\u5728\u7684\u95ee\u9898\u53ef\u4ee5\u7531 2023 \u5e74\u7684\u4e00\u7bc7\u7efc\u8ff0\u5f88\u597d\u5730\u603b\u7ed3\uff0c\u8be5\u7efc\u8ff0\u5f97\u51fa\u7ed3\u8bba\uff1a\u201c\u4e34\u5e8a\u533b\u751f\u5728\u5c06\u68c0\u6d4b\u7ed3\u679c\u5e94\u7528\u4e8e\u836f\u7269\u4e34\u5e8a\u51b3\u7b56\u65b9\u9762\u7684\u5dee\u5f02\u5f88\u5927\uff0c\u8bb8\u591a\u4eba\u5bf9\u4e8e\u591a\u5927\u7a0b\u5ea6\u4e0a\u4f9d\u8d56\u8fd9\u4e9b\u7ed3\u679c\u611f\u5230\u4e0d\u786e\u5b9a\uff0c\u5e76\u4e14\u5bf9\u54ea\u4e9b\u60a3\u8005\u4f1a\u4ece PGx \u4e2d\u53d7\u76ca\u7684\u770b\u6cd5\u4e5f\u5404\u4e0d\u76f8\u540c\u3002\u201d18<\/sup>\u00a0 \u4eba\u4eec\u5bc4\u5e0c\u671b\u4e8e\uff0c\u672a\u6765\u57fa\u56e0\u68c0\u6d4b\u5c06\u663e\u8457\u63d0\u9ad8\u6297\u7cbe\u795e\u75c5\u836f\u7269\u6cbb\u7597\u7684\u51c6\u786e\u6027\uff0c\u5e76\u6539\u5584\u60a3\u8005\u7684\u9884\u540e\u3002\u9057\u61be\u7684\u662f\uff0c\u90a3\u4e2a\u672a\u6765\u5c1a\u672a\u5230\u6765\u3002.<\/p>\n

\u5229\u76ca\u51b2\u7a81\uff1a <\/strong>\u6885\u8036\u5c14\u535a\u58eb\u62a5\u544a\u79f0\uff0c\u5728\u8fc7\u53bb24\u4e2a\u6708\u5185\uff0c\u4ed6\u4ece\u4ee5\u4e0b\u516c\u53f8\u83b7\u5f97\u4e86\u6f14\u8bb2\u6216\u54a8\u8be2\u8d39\uff1a\u827e\u4f2f\u7ef4\uff08AbbVie\uff09\u3001\u963f\u5c14\u514b\u6885\u65af\uff08Alkermes\uff09\u3001BioXcel\u3001ITCI\u3001\u5361\u9c81\u7eb3\uff08Karuna\uff09\u3001\u7ebd\u7f57\u514b\u6797\uff08Neurocrine\uff09\u3001\u8bfa\u6587\uff08Noven\uff09\u3001\u5927\u51a2\u5236\u836f\u7f8e\u56fd\u516c\u53f8\uff08Otsuka-USA\uff09\u3001\u4f4f\u53cb\u5236\u836f\uff08Sumitomo Pharma\uff0c\u539fSunovion\uff09\u4ee5\u53ca\u68af\u74e6\uff08Teva\uff09\u3002.<\/p>\n

\u53c2\u8003<\/strong><\/p>\n

    \n
  1. Baune BT. \u7cbe\u795e\u533b\u5b66\u4e2d\u836f\u7269\u57fa\u56e0\u7ec4\u5b66\u7684\u4e34\u5e8a\u5e94\u7528\uff1a\u672a\u6765\u5c1a\u672a\u5230\u6765\u3002Eur Neuropsychopharmacol 2022;58:4-6.<\/li>\n
  2. Bousman CA, Dunlop BW. \u5546\u4e1a\u5316\u836f\u7406\u9057\u4f20\u5b66\u51b3\u7b56\u652f\u6301\u5de5\u5177\u5728\u57fa\u56e0\u578b\u3001\u8868\u578b\u53ca\u7528\u836f\u5efa\u8bae\u65b9\u9762\u7684\u4e00\u81f4\u6027\u3002\u300a\u836f\u7406\u9057\u4f20\u5b66\u6742\u5fd7\u300b2018;18:613-22.<\/li>\n
  3. Nurnberger JI, Jr. \u7b49\u3002\u7cbe\u795e\u79d1\u533b\u751f\u5e94\u4e86\u89e3\u54ea\u4e9b\u9057\u4f20\u5b66\u77e5\u8bc6\uff1f\u56fd\u9645\u7cbe\u795e\u75c5\u9057\u4f20\u5b66\u5b66\u4f1a\u4f4f\u9662\u533b\u5e08\u6559\u80b2\u59d4\u5458\u4f1a\u7684\u7efc\u8ff0\u4e0e\u5efa\u8bae\u3002\u300a\u4e34\u5e8a\u7cbe\u795e\u75c5\u5b66\u6742\u5fd7\u300b2018;80\u3002.<\/li>\n
  4. Zeier Z \u7b49\u3002\u6297\u6291\u90c1\u836f\u5904\u65b9\u4e2d\u836f\u7269\u57fa\u56e0\u7ec4\u5b66\u51b3\u7b56\u652f\u6301\u5de5\u5177\u7684\u4e34\u5e8a\u5e94\u7528\u3002\u300a\u7f8e\u56fd\u7cbe\u795e\u75c5\u5b66\u6742\u5fd7\u300b2018;175:873-86\u3002.<\/li>\n
  5. Bousman CA \u7b49. \u7cbe\u795e\u75c5\u5b66\u4e2d\u836f\u7269\u57fa\u56e0\u7ec4\u5b66\u68c0\u6d4b\u7684\u7efc\u8ff0\u4e0e\u5171\u8bc6\u3002\u300a\u836f\u7406\u7cbe\u795e\u75c5\u5b66\u300b2021;54:5-17.<\/li>\n
  6. Greden JF, \u7b49\u3002\u836f\u7269\u57fa\u56e0\u7ec4\u5b66\u5bf9GUIDED\u8bd5\u9a8c\u4e2d\u91cd\u5ea6\u6291\u90c1\u75c7\u60a3\u8005\u4e34\u5e8a\u7ed3\u5c40\u7684\u5f71\u54cd\uff1a\u4e00\u9879\u5927\u578b\u3001\u60a3\u8005\u548c\u8bc4\u4f30\u8005\u76f2\u6cd5\u3001\u968f\u673a\u3001\u5bf9\u7167\u7814\u7a76\u3002J Psychiatr Res 2019;111:59-67\u3002.<\/li>\n
  7. \u962eCJ\u7b49\u3002\u63a2\u8ba8\u6c2f\u6c2e\u5e73C\/D\u6bd4\u503c\u504f\u4f4e\u3001\u6c2f\u6c2e\u5e73-\u53bb\u7532\u6c2f\u6c2e\u5e73\u6bd4\u503c\u5012\u7f6e\u53ca\u65e0\u6cd5\u68c0\u6d4b\u5230\u7684\u836f\u7269\u6d53\u5ea6\u4f5c\u4e3a\u6c2f\u6c2e\u5e73\u60a3\u8005\u672a\u9075\u533b\u5631\u6cbb\u7597\u7684\u6307\u6807\uff1a\u6587\u732e\u7efc\u8ff0\u53ca\u6765\u81ea3\u9879\u7814\u7a76\u768417\u4f8b\u60a3\u8005\u75c5\u4f8b\u7cfb\u5217\u3002 \u300a\u7cbe\u795e\u5206\u88c2\u75c7\u7814\u7a76\u300b2023:doi: 10.1016\/j.schres.2023.07.002. \u7f51\u7edc\u9996\u53d1<\/em><\/strong>.<\/li>\n
  8. Schoretsanitis G, et al. \u4f18\u5316\u4e34\u5e8a\u5b9e\u8df5\u4e2d\u6297\u7cbe\u795e\u75c5\u836f\u7269\u6cbb\u7597\u7684\u8840\u836f\u6d53\u5ea6\uff1a\u7f8e\u56fd\u4e34\u5e8a\u7cbe\u795e\u836f\u7406\u5b66\u5b66\u4f1a\uff08ASCP\uff09\u4e0e\u795e\u7ecf\u7cbe\u795e\u836f\u7406\u5b66\u4e0e\u836f\u7269\u7cbe\u795e\u75c5\u5b66\u7814\u7a76\u5de5\u4f5c\u7ec4\uff08AGNP\uff09\u6cbb\u7597\u836f\u7269\u76d1\u6d4b\uff08TDM\uff09\u5de5\u4f5c\u7ec4\u7684\u8054\u5408\u5171\u8bc6\u58f0\u660e\u3002J Clin Psychiatry 2020;81:doi: 10.4088\/JCP.19cs13169.<\/li>\n
  9. Meyer JM, Stahl SM. \u300a\u6297\u7cbe\u795e\u75c5\u836f\u7269\u8840\u6d46\u6d53\u5ea6\u7684\u4e34\u5e8a\u5e94\u7528\u2014\u2014\u65af\u5854\u5c14\u624b\u518c\u300b\u3002\u7ebd\u7ea6\u5dde\u7ebd\u7ea6\u5e02\uff1a\u5251\u6865\u5927\u5b66\u51fa\u7248\u793e\uff1b2021\u5e74\u3002.<\/li>\n
  10. Olesen OV, Linnet K. \u4e94\u79cd\u4eba\u7c7b\u7ec6\u80de\u8272\u7d20P450\u540c\u5de5\u9176\u5bf9\u4f4e\u6d53\u5ea6\u548c\u9ad8\u6d53\u5ea6\u4e0b\u6c2f\u6c2e\u5e73\u4f53\u5916N-\u53bb\u7532\u57fa\u5316\u7684\u8d21\u732e\u3002\u300a\u4e34\u5e8a\u836f\u7406\u5b66\u6742\u5fd7\u300b2001;41:823-32.<\/li>\n
  11. Rostami-Hodjegan A \u7b49\u3002\u5242\u91cf\u3001\u5438\u70df\u3001\u5e74\u9f84\u3001\u6027\u522b\u548c\u4ee3\u8c22\u6d3b\u6027\u5bf9\u8840\u6d46\u6c2f\u6c2e\u5e73\u6d53\u5ea6\u7684\u5f71\u54cd\uff1a\u4e00\u79cd\u7528\u4e8e\u8f85\u52a9\u6c2f\u6c2e\u5e73\u5242\u91cf\u8c03\u6574\u53ca\u8bc4\u4f30\u4e2a\u4f53\u60a3\u8005\u4f9d\u4ece\u6027\u7684\u9884\u6d4b\u6a21\u578b\u548c\u9884\u6d4b\u56fe\u3002 \u300a\u4e34\u5e8a\u7cbe\u795e\u836f\u7406\u5b66\u6742\u5fd7\u300b2004;24:70-8.<\/li>\n
  12. Loi CM \u7b49\u3002\u54ea\u4e9b\u4ee3\u8c22\u7269\u4f1a\u8fdb\u5165\u8840\u6db2\u5faa\u73af\uff1f\u300a\u836f\u7269\u4ee3\u8c22\u4e0e\u6392\u6cc4\u300b2013;41:933-51\u3002.<\/li>\n
  13. Schoretsanitis G, et al. A comprehensive review of the clinical utility of and a combined analysis of the clozapine\/norclozapine ratio in therapeutic drug monitoring for adult patients. Expert Rev Clin Pharmacol 2019;12:603-21.<\/li>\n
  14. Fromm MF. MDR1\u591a\u6001\u6027\u5bf9\u4eba\u7c7bP-\u7cd6\u86cb\u767d\u8868\u8fbe\u548c\u529f\u80fd\u7684\u5f71\u54cd\u3002\u300a\u836f\u7269\u9012\u9001\u8fdb\u5c55\u300b2002;54:1295-310.<\/li>\n
  15. Boulton DW \u7b49\u3002\u975e\u5178\u578b\u548c\u4f20\u7edf\u6297\u7cbe\u795e\u75c5\u836f\u7269\u5bf9P-\u7cd6\u86cb\u767d\u7684\u4f53\u5916\u4eb2\u548c\u529b\u3002\u300a\u751f\u547d\u79d1\u5b66\u300b2002;71:163-9\u3002.<\/li>\n
  16. Consoli G, et al. ABCB1 polymorphisms are associated with clozapine plasma levels in psychotic patients. Pharmacogenomics 2009;10:1267-76.<\/li>\n
  17. Schmitt U, et al. \u975e\u5178\u578b\u6297\u7cbe\u795e\u75c5\u836f\u7269\u5bf9\u4f53\u5916P-\u7cd6\u86cb\u767d\u5916\u6392\u7684\u6291\u5236\u5728\u4f53\u5185\u80fd\u5f88\u597d\u5730\u901a\u8fc7\u836f\u6548\u5b66\u53d8\u5316\u53cd\u6620\u51fa\u6765\uff0c\u4f46\u901a\u8fc7\u836f\u4ee3\u52a8\u529b\u5b66\u53d8\u5316\u53cd\u6620\u5219\u8f83\u5c11\u3002Pharmacol Biochem Behav 2012;102:312-20.<\/li>\n
  18. Vest BM, \u7b49. \u4e34\u5e8a\u533b\u5e08\u5229\u7528\u836f\u7269\u57fa\u56e0\u7ec4\u5b66\u68c0\u6d4b\u6307\u5bfc\u6297\u6291\u90c1\u836f\u5904\u65b9\uff1a\u5b9a\u6027\u8bbf\u8c08\u7ed3\u679c. Psychiatr Serv 2023:doi: 10.1176\/appi.ps.20220537. \u7f51\u7edc\u9996\u53d1<\/em><\/strong>.<\/li>\n<\/ol>\n<\/div><\/div><\/div><\/div><\/div>
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