癫痫患儿丙戊酸钠血药浓度特点及复发风险因素分析

Serum Concentration Characteristics of Valproate and Recurrent Risk Factors in Children with Epilepsy

目的:探讨癫痫患儿服用丙戊酸钠治疗后血药浓度特点及其复发风险因素,为促进患儿合理用药提供参考。方法:收集2019年2月~2020年3月本院108例癫痫患儿基本信息、用药医嘱,及其丙戊酸钠血药浓度检测结果,记录癫痫复发情况。采用线性回归法分析影响患儿血药浓度的相关因素,多因素Cox风险回归法分析影响患儿癫痫复发的独立风险因素。结果:患儿丙戊酸钠平均血药浓度为(69.98±28.73)μg·ml^(-1),3~6岁组患儿血药浓度低于<3岁组和6~17岁组(P<0.05);血药浓度与年龄(r_(s)=0.202,P=0.036)、体质量(r_(s)=0.193,P=0.045)、日剂量(r=0.307,P=0.001)和SCr值(r=0.283,P=0.003)呈正相关,与AST水平(r=-0.197,P=0.041)呈负相关;剂型和联合用药对血药浓度产生显著影响(P<0.05);血药浓度<50μg·ml^(-1)的患儿癫痫复发风险是血药浓度50~100μg·ml^(-1)组的3.064倍[HR=3.064,95%CI:(1.519,6.178),P=0.002],联合用药的患儿癫痫复发风险是单一用药的3.713倍[HR=3.713,95%CI:(1.772,7.778),P=0.001]。结论:患儿服用丙戊酸钠治疗后复发风险与血药浓度和联合用药方案有关,提示应根据血药浓度持续调整剂量,以减少患儿癫痫发作的机会,保证安全合理用药。

Objective:To explore the serum concentration characteristics of valproate in children with epilepsy and the risk factors of recurrence in order to provide reference for promoting rational drug use in children.Methods:Totally 108 children with epilepsy were followed up in our hospital from February 2019 to March 2020.The basic information,medication orders and recurrence of epilepsy were collected and their serum concentrations were determined.Linear regression and Cox risk regression were used to analyze the factors affecting the serum concentration and recurrence in children with epilepsy.Results:The average serum concentration of valproate was(69.98±28.73) μg·ml^(-1),and the valproate serum concentration in children at the age of 3-6 years old was lower than that in children at the age below 3 years old and 6-17 years old(P<0.05).The serum concentration was positively correlated with age(r_(s)=0.202,P=0.036),body weight(r_(s)=0.193,P=0.045),daily dose(r=0.307,P=0.001) and Cr(r=0.283,P=0.003),while negatively correlated with AST(r=-0.197,P=0.041).The dosage form and the multidrug therapy had significant effects on the serum concentration.The recurrence risk of epilepsy was 3.064 times higher in children with the serum concentration below 50 μg·ml^(-1) than that in children with the serum concentration within the range of 50-100 μg·ml^(-1)(HR=3.064,95%CI=1.519-6.178,P=0.002),and 3.713 times higher in children with multidrug therapy than that in children with monotherapy(HR=3.713,95%CI=1.772-7.778,P=0.001).Conclusion:The recurrence risk in children with epilepsy is related to valproate serum concentration and drug regimen,suggesting that the drug regimen and dosage should be adjusted continuously to ensure safe and rational drug use.