6种第二代抗精神病药物治疗药物监测结果的回顾性分析

Retrospective analysis of therapeutic drug monitoring results of six second-generation antipsychotics

目的:分析6种第二代抗精神病药物治疗药物监测结果,为6种药物治疗精神分裂症的个体化、合理化用药提供参考。方法:采用回顾性分析方法,收集西安市精神卫生中心2020年1-12月在门诊及住院进行6种第二代抗精神病药物治疗药物监测的结果。采用Med Calc 5.2医学统计软件进行数据分析。结果:6种药物监测1次频率的比例均为门诊>住院(P<0.01),监测频率2次以上的比例均为住院>门诊(P<0.001)。非参数Mann-Whitney U检验结果显示,女性患者奥氮平、氨磺必利、利培酮+帕立哌酮的血药浓度均高于男性患者,且差异均具有统计学意义(P<0.05);而女性患者喹硫平+去乙基喹硫平血药浓度低于男性患者(P<0.01)。≥60岁患者的氨磺必利、喹硫平+去乙基喹硫平、阿立哌唑+脱氢阿立哌唑血药浓度高于<60岁的患者,且差异均具有统计学意义(P<0.05);而≥60岁患者奥氮平、利培酮+帕立哌酮、氯氮平+去甲氯氮平的血药浓度与<60岁的患者相比,差异无统计学意义(P>0.05)。6种药物及其代谢物中,奥氮平血药浓度在治疗窗比例最高(约为74.98%),氯氮平最低(约为20.53%)。氨磺必利、阿立哌唑、阿立哌唑+脱氢阿立哌唑血药浓度均明显高于共识所推荐参考范围,而氯氮平及去乙基喹硫平血药浓度均明显低于共识所推荐参考范围。结论:在临床实践中,应加强门诊及住院患者治疗药物监测的重视程度,从而为患者实施个体化给药,保障临床用药的安全、有效。

OBJECTIVE To analyze the therapeutic drug monitoring(TDM)results of six second-generation antipsychot⁃ics,and to provide reference for individualized and rationalized schizophrenia treatment.METHODS Retrospective analyses of the TDM results of six second-generation antipsychotics were obtained from the outpatient and inpatient cases in Xi’an Mental Health Center from January 2020 to December 2020.A Med Calc 5.2 statistical software was used to analyze the subsequent data.RESULTS The results showed that the proportion of one TDM in outpatients was significantly higher than that in inpatients(P<0.01).Conversely,the proportion of monitoring frequency more than 2 times was higher in inpatients than that in outpatients(P<0.01).A higher plasma concentration was observed in female patients than in male patients(P<0.05)through the nonpara⁃metric Mann-Whitney U test,including olanzapine,amisulpride,and risperidone+paliperidone,but the plasma concentration of quetiapine+desethylquetiapine was found to be lower in female patients compared to male patients(P<0.01).Furthermore,a higher plasma concentration exposure(including amisulpride,quetiapine+norethylquetiapine,and aripiprazole+dehydroaripipra⁃zole)was identified in patients over or equal to 60 years of age compared to those under 60 years of age(P<0.05),whereas,the olanzapine,risperidone+paliperidone,and clozapine+norclozapine concentrations had no statistically significant differences between the two different age groups(P>0.05).Among all the monitored samples,the blood concentration of olanzapine had the highest proportion in the therapeutic window by 74.98%,and that of clozapine showed the lowest proportion(20.53%).More⁃over,the blood concentrations of amisulpride,aripiprazole and aripiprazole+dehydroaripiprazole were dramatically higher than the reference ranges recommended by the consensus,while those of clozapine and norethylquetiapine were significantly lower than the recommended reference ranges.CONCLUSION In clinical practice,it is essential to monitor drug concentrations for both outpa⁃tients and inpatients,so as to enhance the implementation of individualized drug administration,and ensure the safety and effective⁃ness of clinical medication.