联合用药对卡马西平血浓度及临床疗效的影响

INFLUENCE OF MULTIPLEANTIEPILEPTIC DRUGS ON PLASMA LEV-ELS OF CARBAMAZEPINE AND CARBAMAZEPINE- 10, 11-EPOXlDE AND CLIN-ICAL EFFICACY

采用高性能液相色层分析法对１１８例服用卡马西平的癫痫患儿测定了血卡马西平（ＣＢＺ）及其中间代谢产物１０、１１－环氧卡马西平（Ｅ－ＣＢＺ）药浓度。７８例单用ＣＢＺ，４０例合用其他抗痫药，其中１５例合用苯巴比妥（ＰＢ）、７例合用苯妥英钠（ＰＨＴ）、１０例合用丙戊酸钠（ＶＰＡ－Ｎａ）、８例合用硝基安定（ＮＴＺ）。各组ＣＢＺ平均给药剂量相似。结果表明，合用ＰＢ或ＰＨＴ组血ＣＢＺ药浓度与临床疗效明显低于单药组（Ｐ＜０．０１）。合用ＶＰＡ－Ｎａ组血ＣＢＺ浓度与单药组无显著差异，Ｅ－ＣＢＺ血浓度明显高于单药组（Ｐ＜０．０１），而临床疗效低于单药组（Ｐ＜０．０５）。合用ＮＴＺ组血ＣＢＺ及Ｅ－ＣＢＺ浓度与临床疗效与单药组比较，差异均无显著意义（Ｐ＞０．０５）。提示ＣＢＺ抗痫治疗不宜与ＰＢ或ＰＨＴ合用，Ｅ－ＣＢＺ浓度与临床疗效无相关性。

AbstractPlasma levels of carbamazeoine(CBZ)and carba-niazepine-10.11- epoxide (E-CBZ) in 118 epilepticchildren treated with CBZ alone (78 cases) , and CBZin cornbination with ohenobarbital (PB) (15 cases) ,phenytoin (PHT) (7 cases)>, sodium valproate (VPAnai (10 cases) . nitrazeparn (NTZ) (8 cases) weredeterrnined bv HPLC, and the clinical efficacv wascompared between the diffezant groups.The plasma levels of CBZ and the clinical controlrate in the groups treated with CBZ +PB and CBZ+PHT were significantly lower than those in CBZ alone.The plasma level of E- CBZ in the group treated byCBZ + VPA -na was obviously higher than that ofCBZ alone. There was no significant difference in theplasma level of CBZ between the groups taking CBZalone and CBZ+VPA- na, but the clinical efficacy inthe group of CBZ+VPA-na was poorer than that inCBZ alone. Comparing the group taking CBZ alone andthose taking CBZ+NTZ,4 There was no significant dif-ference both in CBZ and E-CBZ blood levels and clini-cal efficacy betuween the groups taking CBZ alone andCBZ+NTZ;there was no correlaiion between clinicalefficacy and the plasnia level of E-CBZ. Our data sug-gest that in treatrnent of epileiisy, CBZ should not becombined with PB or PHT.