丙戊酸钠的血药浓度及其影响因素分析

Analysis of Blood Concentration of Sodium Valproate and Its Influential Factors

目的:分析丙戊酸钠(VPA)血药浓度及其影响因素,促进临床个体化应用VPA。方法:回顾性分析某三级甲等医院2011-2012年服用VPA的245例癫痫患者的血药浓度监测结果与疗效,逐步回归分析剂量和合并用药等多种因素对血药浓度的影响。结果:VPA平均稳态血药浓度为(45.48±19.11)μg/L。对血药浓度<40μg/L、40～100μg/L与>100μg/L时的疗效分布进行卡方检验可得各组疗效差异有统计学意义(P=0.000)。多元逐步回归结果表明VPA血药浓度的变化与剂量、体质量、年龄、合并用药有关。逐步回归方程:cp=43.953+2.845a1-1.105a2+0.031a3-1.608a6,其中,a1、a2、a3、a6分别表示剂量、体质量、年龄与合并应用苯巴比妥。结论:通过血药浓度监测和分析各影响因素来调整个体化给药剂量,能使VPA的临床应用取得更好的疗效。

OBJECTIVE： To analyze the blood concentration of sodium valproate （VPA） and its influential factors, and to pro- mote individual application of VPA in the clinic. METHODS： By retrospective analysis, the results of VPA blood concentration monitoring and therapeutic efficacy were analyzed among 245 patients treated with VPA from 2011 to 2012. The influence of sever-al factors, such as dose, drug combination, on blood concentration was also analyzed. RESULTS： The average steady concentra-tion of VPA was （45.48 ± 19.11） μg/L. There was statistical difference in efficacy between 〈40 μg/L,40-100 μg/L and 〉100 μg/L through Chi-square test （P=0.000）. The results of multiple stepwise regression showed that blood concentration of VPA was associ-ated with dose, weight, age and drug combination. Stepwise regression equation： cp=43.953＋2.845a1-1.105a2＋0.031a3-1.608a6, in which a1, a2, a3 and a6 represented dose, weight, age and combined use of phenobarbital. CONCLUSIONS： Drug dosage should be adjusted according to the blood concentration monitoring and analysis of influential factors, which can improve therapeutic effica-cy of VPA.