肾功能亢进对左乙拉西坦稳态谷浓度及疗效的影响

Effect of augmented renal clearance on the steady-state trough concentration and efficacy of levetiracetam

目的分析肾功能亢进对左乙拉西坦片稳态谷浓度和疗效的影响。方法回顾性分析2021年6月至2023年8月在解放军总医院接受左乙拉西坦片治疗并进行治疗药物监测(TDM)的住院患者,根据左乙拉西坦片治疗方案分为0.5、1.0、1.5 g 3个剂量组,比较各剂量组内肾功能正常患者和肾功能亢进患者稳态谷浓度和疗效。结果共纳入患者47例,其中肾功能正常患者21例,各剂量组分别12、5、4例;肾功能亢进患者26例,各剂量组分别4、9、13例。各剂量组中肾功能亢进患者的左乙拉西坦稳态谷浓度均显著低于肾功能正常患者(P<0.05)。在1.0、1.5 g剂量组中,肾功能正常患者的稳态谷浓度达标率为100%,癫痫发生率为0%;肾功能亢进患者的稳态谷浓度达标率为54.5%,癫痫发生率为40.9%。结论肾功能亢进患者在不同给药方案下,左乙拉西坦稳态谷浓度达标率均低于肾功能正常患者(P<0.05),且癫痫发生率更高(P<0.05)。对于肾功能亢进患者,应适当地增加用药剂量。

Objective To investigate the effect of augmented renal clearance on the steady-state trough concentration and efficacy of levetiracetam tablets.Methods A retrospective analysis was performed on hospitalized patients who received treatment with levetiracetam tablets and underwent TDM at Chinese PLA General Hospital from June 2021 to August 2023.According to levetiracetam tablets treatment regimen,patients were divided into three dosage groups(0.5 g,1.0 g and 1.5 g).The steady-state trough concentration and efficacy were compared between patients with normal renal function and those with augmented renal clearance within each dosage group.Results A total of 47 patients were included,with 21 patients having normal renal function(12,5 and 4 patients in each dosage group,respectively)and 26 patients having augmented renal clearance(4,9 and 13 patients in each dosage group,respectively).The steady-state trough concentrations of levetiracetam in patients with augmented renal clearance were significantly lower than those in patients with normal renal function in each dosage groups(P<0.05).In the 1.0 g and 1.5 g dosage groups,the rate of achieving target steady-state trough concentration was 100%in patients with normal renal function,with an incidence of epilepsy of 0%;whereas in patients with augmented renal clearance,the rate of achieving target steady-state trough concentration was 54.5%,with an incidence of epilepsy of 40.9%.Conclusion Patients with augmented renal clearance demonstrated lower rates of achieving target steady-state trough concentration compared to those with normal renal function among different dosing regimens(P<0.o5),and exhibited higher incidence of epilepsy(P<0.05).In patients with augmented renal clearance,the initial dose of levetiracetam should be increased appropriately.