癫痫患儿奥卡西平活性代谢产物血药浓度监测结果分析

Serum concentration analysis of oxcarbazepine active metabolite in children with epilepsy

目的分析癫痫患儿奥卡西平活性代谢产物羟基卡马西平（MHD）血药浓度，为临床合理用药提供依据。方法选取2013年10月至2015年12月上海交通大学医学院附属新华医院儿科门诊和病房的987例癫痫患儿，均使用奥卡西平治疗。给药3—5d后于复诊时抽取空腹血，采用高效液相色谱法测定MHD血药浓度。结果以15～35mg／L为MHD的有效血药浓度范围，有54．0％（533／987）患儿的血药浓度在治疗窗内，45．8％（452／987）血药浓度偏低，0．2％（2／987）血药浓度偏高。MHD血药浓度随着患儿年龄的增加而明显升高[0～5、6～14、15～18岁依次为（14．27±0．32）、（16．28±0．22）、（16．46±1．00）mg／L，P〈0．05]。不同性别患儿的MHD血药浓度比较差异无统计学意义（P=0．63）。结论癫痫患儿服用奥卡西平后，其活性代谢产物MHD血药浓度个体差异较大。MHD的血药浓度随年龄的增加而升高。MHD的血药浓度监测有助于及时调整用药剂量，促进奥卡西平个体化用药方案的实施。

Objective To analyze the serum concentration of monohydroxycarbazepine（ MHD）, the active metabolite of oxcarbazepine, in children with epilepsy. Methods Totally 987 epileptic children who were treated with oxcarbazepine from October 2013 to December 2015 in Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine were enrolled. After 3-5 d of treatment, fasting blood was sampled and serum concentration of MHD was detected by high performance liquid chromatography （HPLC） method. Results The therapeutic window of MHD was set as 15-35 mg/L; detection results showed that 54. 0% （533/987） in 987 cases were in this range, 45.8% （452/987） targets were on the low side and 0. 2% （2/987） targets were on the high side. The serum concentration of MHD increased with age[ 0-5 years old： （ 14. 27 ± 0. 32）mg/L, 6-14 years old： （ 16. 28 ± 0. 22） mg/L, 15-18 years old： （ 16. 46 ± 1.00） mg/L, F = 1.69, P 〈 0. 05 ] ; but it had no significant difference between genders （P = 0. 63 ）. Conclusions In the treatment of epilepsy with oxcarbazepine in children, the serum concentration of MHD varies individually. MHD serum concentration increases with age.