基于冶疗药物监测的拉莫三嗪个体化用药分析

Individualized medication analysis of lamotrigine based on therapeutic drug monitoring

目的:探讨拉莫三嗪(LTG)血药浓度与剂量对其疗效的影响,为临床个体化用药提供参考。方法:收集服用LTG的癫痫患者资料,共计67例,分析LTG血药浓度、给药剂量、疗效及不良反应的相关性,对血药浓度和剂量进行回归分析,并对血药浓度、日剂量和疗效进行对比。结果:4例患者发生过敏而停药,56例患者血药浓度处于治疗窗内(3～15μg·mL^(-1)),7例患者血药浓度低于治疗窗,两者给药剂量差异无统计学意义;给药剂量与血药浓度在一定范围内呈正相关。治疗窗组的总有效率为91.07%,显著高于低治疗窗组的57.14%;控制组和显效组的血药浓度显著高于有效组和无效组,有效组的给药剂量显著低于显效组(P <0.05)。3例低治疗窗患者和5例治疗窗内患者联用丙戊酸钠进行治疗。结论:TDM对LTG的治疗有重要指导意义,LTG用药存在个体差异,临床应基于TDM进行LTG个体化用药,以提高疗效,降低不良反应的发生。

Objective: To investigate the influence of the plasma concentration and dose of lamotrigine (LTG) on its efficacy, and provide reference for rational drug use. Methods: Data of 67 epileptic patients taking LTG were collected and the correlation of plasma concentration, clinical effect and adverse reactions were analyzed by regression analysis. Results: Four patients developed allergies resulted in LTG withdrawl. 56 patients had the blood concentrations in the treatment window (3 – 15 μg·mL^-1) except 7 patients. There was no significant difference in dose between the two groups. The plasma concentration of LTG was positively correlated with the dose of LTG. The total effective rate was 91.07% in the treatment window group, which was significantly higher than that of the low treatment window group (57.14%). The blood concentration of LTG in the control and the excellence group was significantly higher than that in the effective and the ineffective group. The dose of the effective group was significantly lower than that of the excellence group (P < 0.05). 3 patients in the low treatment window group and 5 patients in the treatment window group were treated together with sodium valproate. Conclusion: TDM had great significance in the treatment of LTG. There were individual differences in the use of LTG. Individualized use of LTG based on TDM could improve the efficacy and avoid the occurrence of adverse drug reactions.