我院茶碱血药浓度监测及其影响因素综合性评价

Analysis of influence factors on blood concentration monitoring of theophylline in our hospital

目的:抽样分析北京医院20年间(1995年—2015年6月)茶碱血药浓度监测的患者的数据,为茶碱临床安全合理用药和个体化治疗提供依据。方法:通过医院治疗药物检测(TDM)数据库查阅1995年1月—2015年6月茶碱血药浓度监测患者的病例资料,共统计6 770例次患者的血药浓度数据,并对影响血药浓度的因素进行综合评价。结果:在6 770例病例结果中,共有3 357例血药浓度在5~20μg·m L^(-1)的最适宜的有效浓度范围内。血药浓度平均值为(6.04±0.06)μg·m L^(-1),女性的平均血药浓度略高于男性。在年龄方面,年龄越大,茶碱平均血药浓度越高。在数量方面,茶碱检测数量由2001年1 148例降至2014年29例。在联合用药方面,喹诺酮以及大环内酯类抗生素、异烟肼、胃舒平和多潘立酮等药物对血药浓度有影响。结论:我院茶碱用药监测例数逐年下降,茶碱血药浓度范围控制在正常区间较低值范围内,茶碱使用较为合理。按照不同给药剂量的血药浓度结果,0.125 g单次剂量给药,能保证较好的安全性和有效性。性别不同的患者血药浓度无显著性差异,低血药浓度的茶碱类药物(5~10μg·m L^(-1))能有效治疗激素抵抗并具有抗炎作用。根据性别、年龄和单次给药剂量,建立了血药浓度综合性评价方程。

Objective： To analyze the monitoring data of serum theophylline concentration from 1995 to2015 in our hospital for providing the evidence for rational and safety use of theophylline. Methods： The patients＇ data of serum theophylline concentration were collected from the database of TDM in our hospital. The serum theophylline concentrations collected from 6 770 patients in our hospital were analyed,and the factors of blood drug concentration were evaluated comprehensively. Results： Among 6 670 patients,3 357（ 49. 59%） had the effective therapeutic concentration（ 5 ~ 20 μg·m L^-1） with an average value of（ 6. 04 ± 0. 06） μg·m L^-1. In terms of gender,average blood concentration was slightly higher in females than in males without significant difference among sex. In terms of age,the older,the higher of the average blood drug concentration of theophylline. In terms of the monitoring frequency,number of theophylline detection decreased from 1 148（ 2001） to 29（ 2014）. In drug combination,quinolone or macrolide antibiotics combined with theophylline would result in higher drug concentration of theophylline. Conclusion： The number of theophylline monitoring gradually reduced year by year in the hospital,the blood drug concentration of theophylline is under control the normal section,theophylline use seems to be morereasonable. According to different dosage about the results of blood drug concentration,using the dosage 0. 125 g each time can ensure good safety and effectiveness. There was no significant difference in plasma drug concentration between genders. Low blood serum concentration（ 5 ~ 10 μg·m L^-1） of theophylline drugs can effectively treat hormone resistance and has anti-inflammatory effect. According to the sex,age and the dose of single dose,the comprehensive evaluation equation of blood drug concentration was established.