Saito Norihiro, Itoga Masamichi, Minakawa Satoko, Kayaba Hiroyuki
Department of Clinical Laboratory Medicine, Hirosaki University Graduate School of Medicine, Hirosaki City, Aomori, 036-8562, Japan.
Int J Gen Med. 2021 May 10;14:1785-1795. doi: 10.2147/IJGM.S300517. eCollection 2021.
Selective serotonin reuptake inhibitors (SSRIs) and serotonin-noradrenaline reuptake inhibitors (SNRIs) are often used to treat outpatients with psychogenic somatoform symptoms but prove ineffective in some cases. The metabolite 3-hydroxybutyrate (3HB) is currently attracting attention as a marker of the severity of depression. We investigated whether serum 3HB levels in patients with psychogenic somatoform symptoms can predict the effectiveness of sertraline and venlafaxine.
Physical and psychiatric problems were assessed in 132 outpatients, and symptomatic response and serum 3HB concentrations were examined before and after treatment with sertraline (50 mg/day) or venlafaxine (75 mg/day).
In 30.3% of patients with psychogenic symptoms, serum 3HB was above the upper limit of normal (<80 μmol/L). According to multiple logistic regression analysis, only episodes of suicidal ideation showed a significant positive association with elevated 3HB (odds ratio 10.2; 95% confidence interval (CI) 2.46-42.2). The sensitivity of 3HB for the effectiveness of sertraline or venlafaxine for psychosomatic symptoms was 44.6%, but specificity was 93.9%. Hierarchical multiple logistic regression analysis identified 3HB as a better predictor of the effectiveness of medication (odds ratio 10.0; 95% CI, 2.49-40.3) than episodes of suicidal ideation.
The present findings suggest that high serum 3HB levels in patients with psychogenic somatoform symptoms may be associated with suicidal ideation and the effectiveness of sertraline and venlafaxine at low to intermediate doses. The 3HB level may be a good predictor of the effectiveness of medication. Examination of serum 3HB levels may lead to earlier and more appropriate administration of sertraline and venlafaxine.
选择性5-羟色胺再摄取抑制剂（SSRIs）和5-羟色胺-去甲肾上腺素再摄取抑制剂（SNRIs）常用于治疗有精神性躯体形式症状的门诊患者，但在某些情况下证明无效。代谢物3-羟基丁酸（3HB）目前作为抑郁症严重程度的标志物受到关注。我们研究了有精神性躯体形式症状患者的血清3HB水平是否能预测舍曲林和文拉法辛的疗效。
对132名门诊患者的身体和精神问题进行评估，并在使用舍曲林（50毫克/天）或文拉法辛（75毫克/天）治疗前后检查症状反应和血清3HB浓度。
在有精神性症状的患者中，30.3%的患者血清3HB高于正常上限（<80微摩尔/升）。根据多因素逻辑回归分析，只有自杀意念发作与3HB升高呈显著正相关（比值比10.2；95%置信区间（CI）2.46 - 42.2）。3HB对舍曲林或文拉法辛治疗心身症状疗效的敏感性为44.6%，但特异性为93.9%。分层多因素逻辑回归分析确定，与自杀意念发作相比，3HB是药物疗效更好的预测指标（比值比10.0；95% CI，2.49 - 40.3）。
目前的研究结果表明，有精神性躯体形式症状患者的高血清3HB水平可能与自杀意念以及低至中等剂量舍曲林和文拉法辛的疗效相关。3HB水平可能是药物疗效的良好预测指标。检测血清3HB水平可能导致更早、更合适地使用舍曲林和文拉法辛。
