113例抗癫痫药物监测结果分析

Analysis of serum concentrations of anti-epilepsy drugs in 113 case-times

目的分析抗癫痫药物血药浓度监测结果，为临床个体化给药提供参考。方法采用均相酶放大免疫检测技术（EMIT）测定抗癫痫药物血药浓度，并用SPSS16．0软件对113例血药浓度监测结果进行分析比较。分析年龄、性别、合并用药等因素对血药浓度的影响以及血药浓度与疗效之间的关系。结果24例卡马西平血药浓度监测结果中，血药浓度〈4μg／ml2例，病情完全控制；4-12μg／ml19例，总有效率（完全控制＋有效）为78．95％；〉12μg／ml3例，总有效率为66．67％。74例丙戊酸血药浓度监测结果中，血药浓度〈50μg／ml24例，总有效率为79．17％；50-100μg／ml43例，总有效率为81．40％；〉100μg／ml7例，总有效率为71．43％。联合卡马西平用药的13例，血药浓度达到有效浓度范围的百分率为61．54％；联合丙戊酸用药的12例，血药浓度达到有效浓度范围的百分率为16．67％。年龄、性别、合并用药等因素对血药浓度的影响及血药浓度与疗效之间均无统计学差异（P〉0．05）。结论抗癫痫药物血药浓度个体差异大，仅凭借所监测的血药浓度来调整剂量是片面的。在临床治疗中有效血药浓度只能作为一重要参考指标，应根据患者的病情控制情况，结合血药浓度监测结果及时调整给药剂量，以期用最小给药剂量，达到最佳治疗效果。

Objective To provide some references for clinical individualized mediaction analyzing the serum concentrations of anti-epilepsy drugs. Methods Enzyme-mutiplied immunoassay technique （EMIT） was used to determine the serum concentrations of anti-epilepsy drugs in 113 case-times, then theconcentrations were analyzed and compared with SPSS 16.0. The impact of age, sex, and drug combination on the serum concentrations of anti-epilepsy drugs and the relation between the serum concentrations of anti- epilepsy drugs and therapeutic effect were analyzed. Results Among the serum concentrations of carbamazepine in 24 case-times, 2 case-times whose diseases were totally controlled were lower than 4 μg/ml; 19 case-times between 4 and 12 μg/ml, with an effective rate of 78.95%; 3 case-times higher than 12 μg/ml, with an effective rate of 66.67%. Among the serum concentrations of valproie acid in 74 case-times, 24 case-times were lower than 50 μg/ml, with an effective rate of 79.17%; 43 case-times between 50 and 100 μg/ml, with an effective rate of 81.40%; 7 case-times higher than 100 μg/ml, with an effective rate of 71.43%. Drug combination with carbamazepine had 13 case-times; 61.54% of the serum concentrations were within the effective range. Drug combination with valproic acid had 12 case-times; 16.67% of the serum concentrations were within the effective range. The impact of age, sex, and drug combination on the serum concentrations of anti-epilepsy drugs and the relation between serum concentration and therapeutic effect had no difference in statistics. Conclusions There are great individual differences among patients in the serum concentrations of anti- epilepsy drugs. It is unilateral to adjust the dosage of drugs only depending on serum concentration. In clinical treatment, the serum concentrations of anti-epilepsy drugs are only references for adjusting drug dosage. We should adjust the drug dosage in term of the patients＇ conditions and the serum concentration of drug so that the patients will get the best therapeutic effect with a smallest drug dosage.