양극성 정동장애 환자에서 리튬투여에 의한 혈청 Inositol-1-phosphatase 활성도 변화

Abstract

Several lines of possibilities have been proposed about the etiology of bipolar affective disorder in biological, genetic and psychosocial aspect. Abnormal signal transduction system in the bipolar affective disorder has been observed by lithium effect on patients who suffering bipolar affective disorder. The purpose of this study is to inspect the etiology of bipolar affective disorder in biological aspect by measuring the changes of serum inositol-1-phosphatase activity and investing a causal relationship between clinical symptoms and serum inositol-l-phosphatase activities in patients with bipolar affective disorder. The subjects were 18 inpatients who met DSM-IV diagnostic criteria for bipolar affective disorder, manic episode and 15 normal controls. Inositol-1-phosphatase activities were measured in serum by using spectrophotometer. Clinical symptoms of patients were assessed by YMRS at admission day and after 2 weeks lithium treatment. The results obtained were as follows. 1. Inositol-1-phosphatase activities of the patients were increased to about 2 Limes as compared with those of normal controls. 2. The serum inositol-1-phosphatase activities were measured at the before treatment and after 1, 7, 14 days. The levels were decreased gradually to the normal at 14 days. 3. YMRS(Young's Mania Rating Scale) scores were decreased significantly by lithium treatment. 4. Statistical significance could not be found between the change of YMRS scores and the levels of inositol-1-phosphatase activity. In this study, statistical significance could not be found between clinical improvement and inositol-1-phosphatase activities, but the fact that lithium treatment improve the clinical manifestation shown by YMRS score changes, and reverse the increased inositol-1-phosphatase activities suggests the strong association between pathophysiology of bipolar affective disorders and inositide metabolism.;양극성 정동장애(bipolar affective disorder)는 생물학적 이상으로 인해 발생한다고 알려지고 있다. 리튬(lithium)은 양극성 정동장애에 대한 대표적 치료제이므로, 리튬의 작용기전을 연구함으로써 양극성 정동장애의 병인을 규명하고자 본 연구를 수행하였다. DSM-Ⅳ 진단기준에 의해 양극성 정동장애 조증삽화로 진단된 18명의 환자에서 리튬 투여 전·후 inositol-1-phosphatase 활성도의 변화를 측정하였고, 임상증상의 변화를 YMRS ( Young's Mania Rating Scale)(Young 등, 1978)로 평가하여 다음과 같은 결과를 얻었다. 1. 리튬을 투여하기 전 환자군의 혈청 inositol-1-phosphatase 활성도는 정상 7 대조군 값에 비해 2.0-2.5배 증가되었다. 2. 환자군에서 리튬 투여 1일, 7일, 14일 후의 혈청 inositol-1-phosphatase 활성도는 계속 감소하여 정상 대조군 값에 근접하였다. 3. 환자군에서 리튬투여 전과 투여 14일 후에 YMRS (Young's Mania Rating Scale)(Young등, 1978)를 사용하여 임상증상의 변화를 평가한 결과 리튬치료에 의해 YMRS 값이 감소하여 임상증세 호전이 관찰되었다. 4. 리튬 투여에 의한 YMRS 값의 변화와 혈청 inositol-1-phosphatase의 활성도의 변화사이에는 통계적으로 유의한 연관성은 발견할 수 없었다. 양극성 정동장애에서 inositol-1-phosphatase 활성도가 높아져 있고 리튬투여에 의해 임상증세가 호전됨과 동시에, inositol-1-phosphatase의 활성도가 정상화되어 inositol-1-phosphatase를 포함하는 inositide 대사의 이상이 이 질환의 발병기전에 관여함을 알 수 있었다.