Evaluation value of serum TPH and GSK-3β levels in the precision treatment of lamotrigine for adoles-cent bipolar disorder depression episodes
Objective To explore the value of serum tryptophan hydroxylase(TPH)and glycogen synthase kinase 3β(GSK-3 β)levels in evaluating the efficacy of lamotrigine precise therapy for depressive episodes in adolescents with bipolar disorder(BD).Methods A retrospective study was conducted to collect clinical data of 187 adolescent patients with bipolar disorder(BD)depression episodes admitted to the Seventh People's Hospital of Wenzhou from June 2022 to April 2023.Received precision therapy with lamotrigine,and the treatment effect was evaluated after 4 weeks of treatment.According to the treatment effect,the patients were divided into an ef-fective group and an ineffective group.The baseline data,serum TPH and GSK-3 β levels before treatment were compared between the two groups.The correlation between serum TPH and GSK-3β levels was tested using bi-variate Pearson correlation analysis.The impact of serum TPH and GSK-3 before treatment on the efficacy of pre-cision therapy with lamotrigine for BD depression episodes was analyzed.Furthermore,the predictive value of serum TPH and GSK-3 β levels before treatment in assessing the efficacy of precision therapy with lamotrigine for BD depression episode was alaso analyzed.Results A total of 187 adolescent patients with BD depression episodes were treated with precision therapy using lamotrigine for 4 weeks,156 cases were effective,31 cases were ineffective,with an effective rate of 83.4％.The serum TPH level before treatmeng in the ineffective group was lower than that in the effective group,while the serum GSK-3β level was higher than that in the effective group(t=6.920,4.648,P＜0.001).Bivariate Preason correlation analysis showed that a negative correlation between serum TPH and GSK-3β levels before treatment in children with BD depressive episodes(r=-0.173,P=0.018).Multivariate logistic regression analysis revealed that serum TPH and GSK-3β levels before treatment were inde-pendent risk factors for the efficacy of precision therapy with lamotrigine for BD depressive episodes(P＜0.05).The ROC curve showed that the AUC of serum TPH and GSK-3β levels alone or combined in predicting and evaluat-ing the efficacy of BD depressive episodes in children was greater than 0.70,indicating a certain predictive value.The decision curve analysis revealed that within the threshold range of 0.0-1.0,the net benefit of combined pre-diction and evaluation of serum TPH and GSK-3β before treatment for the efficacy of precision therapy with lamot-rigine in children with BD depression episodes was superior to the net benefit of either alone,and the net benefit of enther alone,and the net benefit was greater than 0,suggesting clinical significance.Conclusion Serum TPH and GSK-3β levels have good predictive value in evaluating the efficacy of precision therapy with lamotrigine for adolescent BD depression episodes.
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