基于治疗药物监测的齐拉西酮血药浓度/日剂量影响因素分析

Influence factors of drug concentration/dose of ziprasidone based on therapeutic drug monitoring

目的分析精神障碍患者服用齐拉西酮后血药浓度/日剂量(C/D)的影响因素,为齐拉西酮的合理用药提供参考。方法回顾性收集首都医科大学附属北京安定医院2019—2021年服用齐拉西酮的185例住院患者病历资料,采用SPSS 21.0分析性别、年龄、体质量指数(BMI)、日剂量以及联合用药对齐拉西酮C/D的影响。结果齐拉西酮血药浓度(116.19±73.73)ng·mL^(-1),C/D(1.21±0.72)(ng·mL^(-1))/(mg·d^(-1))。女性组齐拉西酮C/D显著高于男性组,体重正常组C/D显著高于超重组,联合使用丙戊酸组显著低于未联合使用组,联合使用劳拉西泮组显著高于未联合使用组(P均<0.05);年龄和日剂量对齐拉西酮C/D无显著影响。结论齐拉西酮血药浓度个体间差异大,影响因素复杂,性别、BMI及联合用药均可能引起血药浓度变化,临床应用时应结合疗效与治疗药物监测进行治疗方案的优化。

Objective To determine the factors affecting the serum concentration/dose(C/D)of ziprasidone in patients with mental disorders,and to provide reference for clinical rational drug use.Methods We retrospectively collected the medical records of 185 inpatients with mental disorders who received ziprasidone treatment in Beijing Anding Hospital,Capital Medical University from 2019 to 2021.The effect of gender,age,body mass index(BMI),dosage and drug combination on C/D was statistically analyzed by SPSS 21.0.Results The serum concentration and C/D of ziprasidone was(116.19±73.73)ng·mL^(-1) and(1.21±0.72)(ng·mL^(-1))/(mg·d^(-1))respectivetly.The C/D of ziprasidone in the female group was higher than that in the male group,the C/D of the normal weight group was higher than that of the overweight group,the C/D of valproate group was lower than that of the non-valproate group,the C/D of lorazepam group was higher than that of the non-lorazepam group(P all<0.05).No significant difference in C/D between age ang dosage was found.Conclusion The serum concentrations of ziprasidone vary greatly among individuals with complicated influential factors.Gender,BMI and medication combination might cause fluctuations in the serum concentration of ziprasidone.We should combine clinical efficacy and therapeutic drug monitoring to optimize therapeutic regimen.