憂鬱症患者之中醫證型與週邊淋巴球 mRNA之表現

藍先元
中國醫藥大學附設醫院
憂鬱症（major depressive disorder）在全球造成嚴重的失能及經濟負擔，是一個複雜而多因子的疾病，無法以單一基因或單一環境因素解釋其病因。目前診斷憂鬱症僅能依據臨床表現，仍缺乏可靠的生物標記。儘管有針對不同神經遞質(如：血清素、正腎上腺素、多巴胺等)系統所發展出的多種抗鬱劑，但在療效上仍有侷限，且缺乏個別化治療的依據。傳統中醫學將憂鬱症分成數種證型，且各有其治療方向。病因學的研究中，已有許多候選基因被探討，例如：5-HTT、MAOA、BDNF等；而mRNA不同於終生不變的基因型，其表現量會隨著環境而變化，所以mRNA更能反應基因與環境因子的交互關係。近年有研究發現憂鬱症患者DRD4受體之mRNA較之正常人為低，而週邊淋巴球之CREB mRNA表現則與正常人無異。然而，其他候選基因仍尚未有系統性之研究。本案為兩年期計畫，我們計畫由精神科門診收案75位未服藥之憂鬱症患者(符合DSM-IV診斷)，及75位健康對照組(年齡性別相稱於患者組)。所有憂鬱症患者均接受中醫辨症分型，及漢氏憂鬱量表評量憂鬱症之嚴重度。兩組個案均採靜脈血萃取mRNA。我們將採用cDNA微列陣技術，它可以同時檢測數千個基因表現。
關鍵字：憂鬱症；mRNA；淋巴球；微列陣；real time RT-PCR

Depression patients: Chinese medicine viewpoints and mRNA expressions in peripheral lymphocytes

Hsien-Yuan Lane
China Medical University Hospital
Major depressive disorder (MDD), causing considerable disability and burdens worldwide, is a complex and multifactorial disease. It cannot be ascribed to mutations in a single gene or to a single environmental factor. At present, its diagnosis depends on clinical manifestation rather than biological markers. Although there have been many kinds of antidepressants which target different neurotransmitter systems (e.g. serotonin, norepinephrine, dopamine etc.), clinical efficacy is still limited and the guides for individualized therapy are still lacking. In traditional Chinese medicine, depression was classified into several phenotypes which need different therapeutic approaches. Many candidate genes, such as 5-HTT, MAOA, BDNF, have been explored in pathophysiology studies. Unlike the constant genotypes, mRNA expressions may swing with environmental changes. That is, mRNA expression may reflect the interaction of genes and environment. Recently it was reported that DRD4 receptor mRNA was lower in MDD patients than in normal controls, whereas CREB mRNA levels of peripheral lymphocytes did not differ with controls. Nevertheless, other candidate genes have not been studied systematically.
關鍵字：Depression；mRNA；Lymphocyte；microarray；real time RT-PCR