多奈哌齐治疗Alzheimer’s病有效血药浓度及影响因素

Effective plasma concentration and influencing factors of donepezil in the treatment of Alzheimer’s disease

多奈哌齐(DNP)是治疗轻中度Alzheimer’s病(AD)的一线用药,有效的药物浓度是提高大脑皮质乙酰胆碱含量、改善认知的关键。DNP治疗轻中度AD患者的疗效和血药浓度密切相关,推荐剂量下,给药剂量越高,效果越显著。影响多奈哌齐血药浓度及治疗效果的因素主要包括载脂蛋白E、肝药酶CYP 2D6、肝药酶CYP 3A4、年龄、雌激素受体、肝功能、肾功能、对氧化酶、丁酰胆碱酯酶、乙酰胆碱受体亚基及血药浓度检测手段等。本文就血药浓度的监测及影响因素的研究进展进行探讨,以期为临床合理、精准及个体化用药提供参考。

Donepezil is a first-line treatment for mild to moderate Alzheimer’s disease(AD). Constant and effective plasma concentration is the key to increase acetylcholine content in the cerebral cortex and improve cognition. The efficacy of donepezil in the treatment of patients with mild to moderate AD is closely related to plasma concentration. The dose is higher, the effect is more significant at the recommended dose. The main factors affecting the plasma concentration and therapeutic effect of donepezil are apolipoprotein E, cytochrome CYP 2 D6, cytochrome CYP 3 A4, age, estrogen receptor, liver function, renal function, peroxidase, butyrylcholine ester enzymes, acetylcholine receptor subunits and plasma drug concentration detection methods. This paper discusses the research progress of monitoring of plasma drug concentration and the influencing factors, to provide a reference for clinical rational, accurate and individualized medication.