癫痫患儿丙戊酸钠血药浓度影响因素间交互作用的研究

Interaction of Influence Factors for Sodium Valproate Plasma Concentrations in Children with Epilepsy

目的探讨影响丙戊酸钠血药浓度的各因素间是否存在交互作用,并考查交互作用对丙戊酸钠血药浓度的影响是否具有临床意义。方法 128例癫痫患儿口服相应剂量的丙戊酸钠并测定其血药浓度。使用方差分析探讨各因素的主效应及交互效应,进一步利用方差成分分析探讨交互效应对血药浓度的影响程度。结果方差分析发现年龄(F=11.276,P=0.001)、体质量(F=5.537,P=0.002)、剂量(F=14.346,P=0.000)、体表面积(F=10.784,P=0.000)及剂量×体表面积的二维交互作用(F=3.410,P=0.002)、剂量×体质量×体表面积的三维交互作用(F=4.306,P=0.007)对血药浓度的影响有统计学意义(P<0.05)。方差成分分析发现剂量×体质量×体表面积的三维交互作用占总的方差成分估计值28.04%,占剂量的各阶效应45.06%。二维交互作用占总的方差成分估计值4.61%,占剂量的各阶效应7.41%。结论在使用丙戊酸钠除考虑年龄、体质量、剂量、体表面积等主效应外,还应考虑三维交互效应的影响。二维交互效应的影响可以忽略。

Objective To investigate whether there were interactions among the influencing factors of sodium valproate plasma concentrations,and investigate whether the interactions were important for clinical work. Methods Plasma concentrations of sodium valproate of 128 epilepsy children were measured after they took orally the corresponding doses.The main effect and interaction effects of the influencing factors of sodium valproate plasma concentrations were investigated by using variance analysis,and the influenced grades of interaction effects to the plasma concentrations were further investigated by using variance component analysis. Results The variance analysis found that the age（F=11.276,P=0.001）,body weight（F=5.537,P=0.002）,dose（F=14.346,P=0.000）,body surface area（F=10.784,P=0.000）,two-dimension interaction of dose × body surface area（F=3.410,P=0.002）,and three-dimension interaction of dose × body weight × body surface area（F=4.306,P=0.007）influenced valproate plasma concentrations significantly（P0.05）.And the variance component analysis showed that the three-dimension interaction accounted for 28.04% of the total variance analysis estimate and 45.06% of the various effects of dose;and two-dimension interaction accounted for 4.61% of the total variance analysis estimate and 7.41% of the various effects of dose. Conclusion Apart from the main effects of age,weight,dose and body surface area,the three-dimension interaction should be considered,but the two-dimension interaction can be ignored as sodium valproate is used.