卡马西平治疗癫痫部分性发作疗效和血浓度的关系

Relationship between clinical effect of carbamazepine in epileptic patients with partial seizures and plasma carbamazpin level

目的 研究单用卡马西平(CBZ)治疗癫痫部分性发作患者最佳血药浓度和合用丙戊酸钠(VPANa)时对CBZ血浓度的影响。方法 采用高效液相色谱法对80例癫痫部分性发作患者测定稳态时血CBZ浓度,其中单服CBZ67例,合并丙戊酸钠13例。并对测定结果与临床疗效的关系进行分析。结果 血CBZ浓度在9～109mg·L-1时控制临床发作的显效率及控制率最高;血CBZ浓度在11～12mg·L-1时脑电图好转率及基本正常率最高,但与血CBZ浓度9～109mg·L-1时脑电图好转率及基本正常率相比差异无显著性(P>005)。临床毒副作用发生率以血CBZ浓度11～12mg·L-1时最高。合用VPANa组血CBZ浓度低于单用CBZ组血浓度(P<001)。结论 卡马西平治疗癫痫部分性发作的最佳血药浓度为9～109mg·L-1,合用VPANa可降低血CBZ浓度。

Objective To study the most effective plasma carbamazpin (CBZ) level in epileptic patients with partial seizures taking CBZ monotherapy and the effect of combined volproic acid (VPA Na) therapy on the plasma concentration of CBZ. Methods We measured the plasma steady state CBZ of 80 epileplic patients with partial seizures by HPLC, 67 in CBZ monotherapy, 13 in combined with VPA Na therapy. The relation between the plasma concentration of CBZ and the clinical effect was analysed. Results There were very significant EEG improvement and reduction in seizure frequency when the plasma concentration of CBZ was 9～10 9 mg·L -1 or 11～12 mg·L -1 ( P <0 05) , but the side effects were more common when the plasma concentration of CBZ was 11～12 mg·L -1 ( P <0 05). The plasma CBZ level in combined VPA Na group was lower than that of CBZ monotherapy ( P <0 01). Conclusion The most effective plasma CBZ level in epileptic patients with partial seizures is 9～10 9 mg·L -1 . Combined VPA Na therapy may lower the plasma CBZ level.