新型抗癫痫药物针对儿童个体化治疗的进展

Advances in the individualized treatment of novel antiepileptic drugs for children

目的:癫痫是危害儿童健康的顽症。为减少抗癫痫药物的不良反应,提高治疗效果和患者生活质量,应对患儿进行个体化治疗。方法:检索CNKI、PubMed等数据库中国内外有关新型儿童抗癫痫药个体化治疗的几种方法,包括利用唾液替代血液进行治疗药物监测、建立群体药动学模型、利用药物基因组学实现个体化治疗等的文献,对其进行整理和归纳。结果:唾液与血液药物浓度存在明显的相关性;某些新型抗癫痫药物的群体药动学模型已经成功建立;ABCB1、ABCC2基因等某些位点的基因多态性可能与耐药性癫痫有关。结论:可以用唾液替代血液进行治疗药物监测;群体药动学模型成功建立为个体化给药提供可能,但目前仍停留在理论阶段;测定基因多态性为耐药性癫痫合理治疗提供依据,有重要临床价值。

OBJECTIVE Epilepsy is a chronic disease endangering childrerrs health. To reduce the adverse effects of antiepi- leptie drugs and improve the treatment and quality of life for patients, individualized drug treatment is needed. METHODS Da- tabases such as CNK1 and PubMed were searched to select and organize literatures on methods of individual antiepileptic drug therapy, including the use of saliva substitute blood for therapeutic drug monitoring, the establishment of a population pharma- cokinetic model and the use of pharmacogenomics. RESULTS Literatures showed significant correlation between saliva and plasma drug concentrations ; population pharmacokinetic model for some new antiepileptic drugs have been successfully estab- lished; gene poIymorphisms at ABCBI and ABCC2 loci may be related with drug resistant epilepsy. CONCLUSION It is feasi ble to use saliva substitute blood for therapeutic drug monitoring; Individualized dosing is becoming possible owing to the sue cessfully established population pharmacokinetic models; the determination of genetic polymorphisms, which has important clinical value, provide the basis for reasonable treatment of drug-resistant epilepsy.