癫痫患者体内丙戊酸钠血药浓度、游离浓度与疗效及不良反应的关系

Correlation between Concentrations of Total,Free Sodium Valproate and Efficacy and Adverse Reactions in Patients with Epilepsy

目的研究癫痫患者体内丙戊酸钠血药浓度、游离浓度与疗效及不良反应的关系,为丙戊酸钠的个体化用药提供依据。方法选取2019年1月至2022年6月在江西省人民医院神经内科就诊并确定为癫痫的82例患者,采用雅培微粒子免疫化学发光法测定其稳态血药浓度和游离浓度,并用SPSS 19.0软件对数据进行分析。结果癫痫治疗总体有效率为81.71%,显效、有效和无效组相比,丙戊酸钠血药浓度、游离浓度和血浆蛋白结合率差异均有统计学意义,P<0.05。男性和女性丙戊酸钠血药浓度、游离浓度和血浆蛋白结合率均差异无统计学意义,P>0.05。中青年组与老年组相比丙戊酸钠血药浓度差异无统计学意义,P=0.283;丙戊酸钠游离浓度和血浆蛋白结合率差异有统计学意义,P<0.05。丙戊酸钠血药浓度<50、50~100、>100 mg/L组,随着丙戊酸钠血药浓度升高,游离浓度也显著升高,不良反应发生率也显著增加,差异有统计学意义,P<0.05。结论癫痫患者体内丙戊酸钠血药浓度、游离浓度存在较大的个体差异,且与疗效和不良反应关系密切,在临床治疗过程中,可以通过监测丙戊酸钠血药浓度、游离浓度来提升其抗癫痫的有效性和安全性。

Objective This research aims to investigate the relationship between concentration of total and free sodium valproate(SV)and efficacy and adverse reactions in epileptic patients,in order to provide evidence for individualized medication of SV.Methods From January 2019 to June 2022,82 patients who were diagnosed as epilepsy in the Department of Neurology of Jiangxi Provincial People's Hospital were selected,and their steady-state concentration of total and free SV were determined by Abbott microparticle immunochemiluminescence assay,and the data were analyzed by SPSS 19.0 software.Results The total effective rate was 81.71%.There was significant difference in total SV concentration,free SV concentration and binding rate of plasma protein(BRPP)between the H-effective,effective,and ineffective groups(P<0.05).There was no significant difference in the total SV concentration,free SV concentration and BRPP between male and female(P>0.05).Between the young and old groups,there was no statistically significant difference in total SV concentration(P=0.283),while significant difference was found in the free SV concentration and in the BRPP(P<0.05).With the increase of total SV concentration(<50,50-100,>100 mg/L),the free SV concentration was also significantly increased,and the incidence of adverse reaction was also significantly increased,the difference was statistically significant(P<0.05).Conclusion The total and free concentration of SV in patients with epilepsy have great individual difference,which are closely related to the efficacy and adverse reactions.In the clinical treatment process,the effectiveness and safety of anti-epilepsy can be improved by monitoring the total and free concentration of SV.