HBV阳性的精神分裂症患者氯氮平血药浓度对照研究

Comparison study of blood clozapine level in schizophrenic pati ents with HBV positive

目的 探讨HBV阳性精神分裂症患者氯氮平血药浓度与不良反应的关系。方法选择符合CCMD - 3及ICD - 10标准的精神分裂症患者为研究对象 ,入组前 1个月未服用过任何抗精神病药物。将HBV感染、且有肝酶升高的患者列为A组 ,HBV感染、肝酶正常的患者列为B组 ,HBV阴性、肝酶正常的患者列为C组 ,每组各 30例。单一服用氯氮平 15 0mg/d ,分 10 :30和 16 :30 2次口服。实验期间禁烟、酒、含咖啡的饮料及浓茶 ;禁用肝药酶诱导剂和抑制剂 ,整个实验期为 3周。在第 3周末 ,用高效液相色谱仪测定氯氮平及去甲氯氮平血药浓度。在第 7,14 ,2 1天分别用TESS对患者不良反应进行评定。结果 氯氮平血药浓度呈现出A组 >B组 >C组的趋势 ,差异非常显著 (P <0 .0 1)。TESS总分A组均显著及非常显著地高于B组和C组 (P <0 .0 5和P <0 0 1) ;A组第 1,2 ,5因子分显著及非常显著地高于C组 (P <0 .0 5和P <0 .0 1) ;A组的第 1,5因子分显著高于B组(P <0 .0 5 ) ;第 3,4 ,6因子分 3组无显著性差异 (P >0 .0 5 )。结论 HBV阳性精神分裂症患者氯氮平血药浓度显著高于阴性者 ,不良反应也相对较重 。

Objective It is to discuss the relationship between b lood clo zapine level and untoward reaction in schizophrenic patients with HBV positive.Methods The patients with schizophrenia which were consistent with CCMD-3 and IC D-10 criteria were chosen as research object, they had not taken any antipsychot ic one month before admission. The patients with HBV positive and liver enzymes increased were in group A, the patients with HBV positive and liver enzymes norm al were in group B, the patients with HBV negative and liver enzymes normal were in group C, there were 30 cases in every group. All the patients only took cloz apine 150 mg/d twice orally. Cigarette, alcohol, coffee, tea and inducer or inhi bitors of liver enzymes were forbidden during the experiment. The whole experime nt period was three weeks. At the end of the third week, the blood clozapine lev el was measured with high performance liquid chromatograph. At the 7th, 14th and 21th day, the untoward reaction was assessed with TESS.Results The blood clozapine level showed tendency of group A > gro up B > group C , there was highly significant difference (P<0.01). The total scores of TESS in group A were higher than that in group B and group C (P<0.05 and P<0 .01).Conclusion The blood clozapine level in schizophrenic patients wit h HBV positive is higher than that in patients with HBV negative. The untoward reaction in sch izophrenic patients with HBV positive is more serious than that in patients with HBV negative. That should evoke to think highly.