Han Claire J, Kohen Ruth, Jun Sangeun, Jarrett Monica E, Cain Kevin C, Burr Robert, Heitkemper Margaret M
Claire J. Han, PhD, RN, is Research Assistant, Department of Biobehavioral Nursing and Health Systems, University of Washington, Seattle. Ruth Kohen, MD, is Associate Professor, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, and Psychiatrist, Geriatric Research, Education and Clinical Center, Veterans Affairs Puget Sound Health Care System, Seattle, Washington. Sangeun Jun, PhD, RN, is Assistant Professor, College of Nursing, Keimyung University, Daegu, South Korea. Monica E. Jarrett, PhD, RN, is Professor, Department of Biobehavioral Nursing and Health Systems, University of Washington, Seattle. Kevin C. Cain, PhD, is Research Scientist, Department of Biostatistics and Office of Nursing Research, University of Washington, Seattle. Robert Burr, MSEE, PhD, is Research Professor, Department of Biostatistics and Office of Nursing Research, University of Washington, Seattle. Margaret M. Heitkemper, PhD, RN, FAAN, is Professor, Department of Biobehavioral Nursing and Health Systems, University of Washington, Seattle.
Nurs Res. 2017 Mar/Apr;66(2):75-84. doi: 10.1097/NNR.0000000000000199.
Our nurse-delivered comprehensive self-management (CSM) program, a cognitive behavioral therapy intervention, is effective in reducing gastrointestinal and psychological distress symptoms in patients with irritable bowel syndrome (IBS). Findings from non-IBS studies indicate that the catechol-O-methyltransferase (COMT) Val158Met polymorphism may moderate the efficacy of cognitive behavioral therapy. It is unknown whether this COMT polymorphism is associated with symptom improvements in patients with IBS.
We tested whether this COMT Val158Met polymorphism influences the efficacy of our 2-month CSM intervention.
We analyzed data from two published randomized controlled trials of CSM. The combined European American sample included 149 women and 23 men with IBS (CSM, n = 111; usual care [UC], n = 61). The primary outcomes were daily reports of abdominal pain, depression, anxiety, and feeling stressed measured 3 and 6 months after randomization. Secondary outcomes were additional daily symptoms, retrospective psychological distress, IBS quality of life, and cognitive beliefs about IBS. The interaction between COMT Val158Met polymorphism and treatment group (CSM vs. UC) in a generalized estimating equation model tested the main objective.
At 3 months, participants with at least one Val allele benefited more from CSM than did those with the Met/Met genotype (p = .01 for anxiety and feeling stressed, and p < .16 for abdominal pain and depression). The moderating effect of genotype was weaker at 6 months.
Persons with at least one Val allele may benefit more from CSM than those homozygous for the Met allele. Future studies with larger and more racially diverse samples are needed to confirm these findings.
Parent studies were registered at ClinicalTrials.gov (NCT00167635 and NCT00907790).
我们由护士提供的综合自我管理（CSM）项目是一种认知行为疗法干预措施，可有效减轻肠易激综合征（IBS）患者的胃肠道和心理困扰症状。非IBS研究的结果表明，儿茶酚-O-甲基转移酶（COMT）Val158Met多态性可能会调节认知行为疗法的疗效。目前尚不清楚这种COMT多态性是否与IBS患者的症状改善有关。
我们测试了这种COMT Val158Met多态性是否会影响我们为期2个月的CSM干预措施的疗效。
我们分析了两项已发表的CSM随机对照试验的数据。合并后的欧美样本包括149名患有IBS的女性和23名男性（CSM组，n = 111；常规护理[UC]组，n = 61）。主要结局是随机分组后3个月和6个月时每天报告的腹痛、抑郁、焦虑和压力感。次要结局是其他每日症状、回顾性心理困扰、IBS生活质量以及对IBS的认知信念。在广义估计方程模型中，COMT Val158Met多态性与治疗组（CSM组与UC组）之间的相互作用检验了主要目的。
在3个月时，至少有一个Val等位基因的参与者从CSM中获益比Met/Met基因型的参与者更多（焦虑和压力感方面p = 0.01，腹痛和抑郁方面p < 0.16）。基因型的调节作用在6个月时较弱。
至少有一个Val等位基因的人可能比Met等位基因纯合的人从CSM中获益更多。需要进行更大规模、种族更多样化样本的未来研究来证实这些发现。
母研究已在ClinicalTrials.gov上注册（NCT00167635和NCT00907790）。
