药物联合前庭康复训练治疗持续性姿势-感知性头晕的效果及与多巴胺受体D2 TaqIA基因多态性的相关性

李蕊; 孟宏涛; 马勇智; 李薇

doi:10.7619/jcmp.20202002

药物联合前庭康复训练治疗持续性姿势-感知性头晕的效果及与多巴胺受体D2 TaqIA基因多态性的相关性

Effect of drugs combined with vestibular rehabilitation training in treating persistent postural-perceptual dizziness and its relationship with dopamine receptor D2 TaqIA gene polymorphism

摘要

摘要:
目的探讨药物联合前庭康复训练治疗持续性姿势-感知性头晕(PPPD)的疗效及与多巴胺受体D2 TaqIA基因多态性的相关性。
方法将60例PPPD患者随机分为对照组(给予盐酸曲舍林片)和联合组(给予盐酸曲舍林片联合前庭康复训练)，每组30例。2组均治疗42 d。采用眩晕残障程度评定量表(DHI)、汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HADA)、艾森克人格量表(EPQ)和躯体分类量表(SOMS-7)评估2组的疗效。采用限制性片段长度多态性聚合酶链反应(PCR-RFLP)和琼脂糖凝胶电泳实验检测多巴胺受体D2 TaqIA基因多态性。
结果联合组治疗第42天时的DHI评分、SOMS-7评分、HAMA评分、HADA评分均低于对照组，差异均有统计学意义(P < 0.05)。2组的PCR扩增条带都位于310 bp左右的位置，条带清晰且明亮，扩增结果良好。PCR-RFLP显示多巴胺受体D2 TaqIA的A1A1多态基因型只有1个310 bp片段, A2A2基因型可被酶切为180、130 bp共2个片段, A1A2杂合基因型被酶切后产生310、180、130 bp共3个片段。2组A1A1、A1A2、A2A2基因型分布以及等位基因A1、A2分布频率比较，差异均有统计学意义(P < 0.05)。相关性分析及多元回归分析发现, A1位点基因的表达频率与PPPD治疗后人格特征趋于稳定呈正相关，且是其独立影响因素。
结论药物联合前庭康复训练治疗PPPD效果显著，且治疗后的稳定型状态与多巴胺受体D2 TaqIA基因A1位点基因高频率表达有关。

Abstract:
Objective To explore the effect of drugs combined with vestibular rehabilitation training in treating persistent postural-perceptual dizziness (PPPD) and its relationship with dopamine receptor D2 TaqIA gene polymorphism.
Methods Totally 60 patients with PPPD were randomly divided into control group (treated with sertraline) and combined group (treated with sertraline and vestibular rehabilitation training), with 30 cases in each group. Both groups were treated for 42 days. The therapeutic effect of the two groups was evaluated by the Dizziness Handicap Inventory (DHI), the Hamilton Anxiety Scale (HAMA), the Hamilton Depression Scale (HADA), the Eysenck Personality Scale (EPQ) and the Screening for Somatoform Symptoms-7 (SOMS-7). Polymorphism of dopamine receptor D2 TaqIA gene was detected by restriction fragment length polymorphism polymerase chain reaction (PCR-RFLP) and agarose gel electrophoresis.
Results The DHI score, SOMS-7 score, HAMA score and HADA score of the combined group on the 42^nd day of treatment were significantly lower than those of the control group (P < 0.05). The PCR bands in both groups were located at about 310 bp, the bands were clear and bright, and the amplification results were good. PCR-RFLP showed that there was only one 310 bp fragment in A1A1 polymorphic genotype of dopamine receptor D2 TaqIA, A2A2 genotype could be digested into two fragments of 180 and 130 bp, and A1A2 heterozygous genotype could produce three fragments of 310, 180 and 130 bp. There were significant differences in the distribution of A1A1, A1A2, A2A2 genotypes and frequencies of allele A1 and A2 between the two groups (P < 0.05). Correlation analysis and multiple regression analysis showed that the frequency of A1 gene was positively correlated with the stability of personality characteristics after treatment for PPPD, and was an independent factor.
Conclusion Drugs combined with vestibular rehabilitation training is effective in the treatment of PPPD, and the stable state after treatment is related to the high frequency of A1 site in dopamine receptor D2 TaqIA gene.

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