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创伤后应激障碍和抑郁症的血液检测会成为现实吗?

Could a blood test for PTSD and depression be on the horizon?

机构信息

a The Psychiatric Institute, Department of Psychiatry , University of Illinois at Chicago , Chicago , IL , USA.

出版信息

Expert Rev Proteomics. 2018 Dec;15(12):983-1006. doi: 10.1080/14789450.2018.1544894. Epub 2018 Nov 20.

DOI:10.1080/14789450.2018.1544894
PMID:30394136
Abstract

Depression and posttraumatic stress disorder (PTSD) are two complex and debilitating psychiatric disorders that result in poor life and destructive behaviors against self and others. Currently, diagnosis is based on subjective rather than objective determinations leading to misdiagnose and ineffective treatments. Advances in novel neurobiological methods have allowed assessment of promising biomarkers to diagnose depression and PTSD, which offers a new means of appropriately treating patients. Areas covered: Biomarkers discovery in blood represents a fundamental tool to predict, diagnose, and monitor treatment efficacy in depression and PTSD. The potential role of altered HPA axis, epigenetics, NPY, BDNF, neurosteroid biosynthesis, the endocannabinoid system, and their function as biomarkers for mood disorders is discussed. Insofar, we propose the identification of a biomarker axis to univocally identify and discriminate disorders with large comorbidity and symptoms overlap, so as to provide a base of support for development of targeted treatments. We also weigh in on the feasibility of a future blood test for early diagnosis. Expert commentary: Potential biomarkers have already been assessed in patients' blood and need to be further validated through multisite large clinical trial stratification. Another challenge is to assess the relation among several interdependent biomarkers to form an axis that identifies a specific disorder and secures the best-individualized treatment. The future of blood-based tests for PTSD and depression is not only on the horizon but, possibly, already around the corner.

摘要

抑郁和创伤后应激障碍(PTSD)是两种复杂且使人衰弱的精神障碍,导致生活质量下降,并对自身和他人产生破坏性行为。目前,诊断主要基于主观而非客观的判断,这导致了误诊和无效治疗。新型神经生物学方法的进步使得评估有前途的生物标志物来诊断抑郁和 PTSD 成为可能,这为患者的恰当治疗提供了新手段。

涵盖领域

血液中的生物标志物发现代表了预测、诊断和监测抑郁和 PTSD 治疗效果的基本工具。改变的 HPA 轴、表观遗传学、NPY、BDNF、神经甾体生物合成、内源性大麻素系统及其作为情绪障碍生物标志物的功能的潜在作用正在被讨论。就此,我们提出了鉴定生物标志物轴的建议,以明确识别和区分具有高共病和症状重叠的疾病,从而为开发靶向治疗提供基础支持。我们还对未来进行早期诊断的血液检测的可行性进行了权衡。

专家评论

已经在患者血液中评估了潜在的生物标志物,需要通过多地点大临床试验分层进一步验证。另一个挑战是评估几个相互依赖的生物标志物之间的关系,以形成一个可以识别特定疾病并确保最佳个体化治疗的轴。用于 PTSD 和抑郁的基于血液的测试的未来不仅在望,而且可能已经临近。

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