基于治疗药物监测的O-去甲基文拉法辛与文拉法辛浓度比值影响因素分析

Analysis of factors affecting the ratio of O-desmethylvenlafaxine to venlafaxine concentration based on therapeutic drug monitoring

目的 探讨O-去甲基文拉法辛与文拉法辛血药浓度比值(ratio of O-desmethylvenlafaxine to venlafaxine concentration,C_(ODV)/C_(VEN))的影响因素。方法 回顾性收集146例次文拉法辛和O-去甲基文拉法辛血药浓度监测的住院患者信息,包括年龄、细胞色素P450 2D6(cytochrome P450 2D6,CYP2D6)基因型、CYP2C19基因型、日剂量、文拉法辛及O-去甲基文拉法辛浓度等信息,用SPSS 16.0软件进行统计分析。结果 <60岁和≥60岁患者的C_(ODV)/C_(VEN)分别为2.09±1.75和3.15±1.99,差异有统计学意义(P<0.05)。CYP2D6慢代谢者(poor metabolizers, PM)、中间代谢者(intermediate metabolizers, IM)和广泛代谢者(extensive metabolizers, EM)的C_(ODV)/C_(VEN)分别为1.48±1.43,2.70±1.71和3.74±2.43,差异均有统计学意义(均P<0.05)。CYP2C19 PM、IM和EM的C/C分别为1.41±1.59,2.47±1.76和2.59±2.33,PM的C_(ODV)/C_(VEN)和IM、EM比较,差异均有统计学意义(均P<0.05)。结论 ≥60岁、CYP2D6 EM的患者可能更适合使用文拉法辛进行治疗。

Objective To explore the influential factors of the ratio of O-desmethylvenlafaxine to venlafaxine concentration(C_(ODV)/C_(VEN)). Methods The clinical information including age, the genotype of cytochrome P450 2 D6(CYP2D6) and CYP2C19, dosing regimen, concentration of venlafaxine and O-desmethylvenlafaxine of 146 hospitalized patients were retrospectively collected and then analyzed by SPSS 16.0 software. Results The C_(ODV)/C_(VEN) in patients<60 years old were significantly lower than the older patients, which were 2.09±1.75 and 3.15±1.99(P<0.05). The C_(ODV)/C_(VEN) of CYP2D6 poor metabolizers(PM), intermediate metabolizers(IM) and extensive metabolizers(EM) were 1.48±1.43, 2.70±1.71 and 3.74±2.43, and the differences were statistically significant(all P<0.05). The C_(ODV)/C_(VEN) in PM of CYP2C19 was 1.41±1.59, it was significantly smaller than IM and EM, which were 2.47±1.76 and 2.59±2.33, respectively(all P<0.05). Conclusion Patients aged ≥60 years or with CYP2D6 EM may be more suitable for treatment with venlafaxine.