癫痫患者卡马西平血药浓度的监测及合理用药研究

Blood concentration monitoring of carbamazepine in epileptic patients and research on rational use of drug

目的分析卡马西平治疗癫痫患者的血药浓度检测结果,探讨卡马西平的合理用药。方法选取癫痫患者94例,采用高效液相色谱法测定患者血清中卡马西平血药浓度,并结合患者用药的临床疗效和不良反应,分析比较各年龄组患者卡马西平的血药浓度及清除率的差异性。结果卡马西平给药量随患者年龄的增加而增加,达到60岁后给药量减少。卡马西平血药浓度随患者年龄的增加而增加,达到60岁后开始降低。卡马西平清除率随患者年龄的增加而减小。同一性别组中,卡马西平清除率随患者年龄的增加而降低,呈现负相关。同一年龄阶段中,部分性别组间相比较,女性的卡马西平血药浓度明显低于男性,女性的卡马西平清除率明显高于男性,差异有统计学意义(P<0.05)。男性患者卡马西平血液浓度普遍维持在8～12 mg/L之间,总有效率为84.8%。女性患者卡马西平血液浓度普遍维持在3～8 mg/L之间,总有效率为87.2%。结论年龄和性别均是癫痫患者卡马西平血药浓度和清除率的影响因素。卡马西平的用药剂量应采取从低到高的方式。调整卡马西平用药剂量时,需在卡马西平血药浓度监测基础上进行,根据癫痫患者的临床疗效和卡马西平血药浓度逐渐增加用药剂量。有效的卡马西平血药浓度监测可以大幅提高抗癫痫药物的安全性及合理性,减少对患者造成的毒副作用。

Objective To analysis the blood concentration monitoring result of carbamazepine in patients with epilepsy and to investigate the rational use of carbamazepine.Methods All 94 patients with epilepsy were selected in the hospital from January 2008 to June 2011.High performance liquid chromatographic method was used for the blood concentration monitoring of carbamazepine in epileptic patients.With a view to clinical efficacy and adverse reaction of therapy in patients with epilepsy,the difference of blood concentration and clearance rate of carbamazepine were analysed and compared between the groups of patients.Results Carbamazepine dosage was increased with the age of patients,and was reduced when patients reached 60 years of age.The blood concentration of carbamazepine increased with patient age,and began to decrease when patients reached 60 years of age.Carbamazepine clearance rate decreased with the age of patients.In the same sex group,carbamazepine clearance increased with increasing patient age,which showed significant negative correlation.In the same age group,sex comparison was made,in which carbamazepine concentration in female was significantly lower than in male,while carbamazepine clearance rate in female was significantly higher than in male.The difference was statistically significant（P〈0.05）.When male patients with carbamazepine blood concentrations generally maintained at 8 - 12 mg / L,and the total efficiency reached 84.8%.When female patients with carbamazepine blood concentrations generally maintained at 3-8 mg/L,and the total efficiency reached 87.2%.Conclusion Age and sex are the factors affecting blood concentration and clearance rate of carbamazepine in patients with epilepsy.Carbamazepine dosage can be taken from low to high.When carbamazepine dosage is adjusted,blood concentration monitoring of carbamazepine must be taken.According to clinical efficacy and plasma concentrations of carbamazepine,dosage should gradually increase.Effective blood concentration monitoring of carbamazepine can substantially improve the antiepileptic drug safety and rationality,which can also reduce toxic side effects caused by carbamazepine.