决策分析在氯氮平治疗药物监测中的应用

The application of decision analysis to the TDM of clozapine

目的 分析氯氮平血药浓度与临床疗效、不良反应关系。方法 氯氮平血药浓度采用HPLC测定 ,用简明精神量表(BPRS)和副作用量表 (TESS)评定氯氮平的疗效和不良反应 ,用决策分析法分析 2 84例服用氯氮平的患者有效数据。结果 氯氮平血药浓度在 2 0 0～ 6 0 0 μg·L-1时疗效好 ,<4 0 0 μg·L-1不良反应轻。结论 考虑到氯氮平的临床疗效和不良反应 ,其治疗窗控制在 2 0 0～ 5 0 0 μg·L-1。

OBJECTIVE: To analyse the relation between serum clozapine level and its efficacy or side effects. METHODS: The serum clozapine level was determined by HPLC. The efficacy and side effects of clozapine were measured by BPRS and TESS. Decision analysis was used to study the relationship between serum clozapine level and the efficacy or side effects. RESULTS: The efficacy of clozapine was best when the serum clozapine levels were over the range of 200 ∼ 600 μg&middotL-1, the mild side effect was found when the serum clozapine levels were over 400 μg&middotL-1. CONCLUSION: It was suggested that the appropriate serum clozapine level should be controlled within 200∼500 μg&middotL-1.