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基于血药浓度监测的丙戊酸钠治疗癫痫384例个体化用药分析
Individualized Use Analysis of Valproate Based on Blood Concentration Monitoring in the Treatment of 384 Cases of Epilepsy
投稿时间:2018-01-15  修订日期:2018-03-08
DOI:
中文关键词:  丙戊酸钠  癫痫  血药浓度  临床疗效  安全性
英文关键词:Valproate  Epilepsy  Blood concentration monitoring  Clinical effect  Safety
基金项目:河南省医学科技攻关计划项目(编号:201602333)
作者单位
何勐1 窦海玲2  周丽娟1 郑州大学附属郑州中心医院 1.转化医学中心2.神经内科 郑州 450007 
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中文摘要:
      摘 要 目的:回顾性分析血药浓度监测(TDM)对丙戊酸钠(VPA)治疗癫痫的指导作用,为临床个体化用药提供参考。方法: 采用回顾性分析方法,收集我院384例单药服用VPA的癫痫患者资料,统计VPA用药和TDM情况,分析血药浓度与疗效及安全性的关系,采用Logistic回归分析年龄、剂量、性别、剂型等多种因素对血药浓度的影响。结果:384例患者中,272例(70.83%)患者血药浓度处于有效范围(50~100 μg·ml-1)。血药浓度50~100 μg·ml-1和血药浓度>100 μg·ml-1范围内患者的临床疗效明显高于血药浓度<50 μg·ml-1范围的患者(P<0.01)。血药浓度>100 μg·ml-1患者的不良反应发生率明显高于血药浓度<50 μg·ml-1和50~100 μg·ml-1范围的患者(P<0.01)。Logistic回归分析表明剂量和年龄对血药浓度有显著影响(P<0.05)。结论:丙戊酸钠用药个体差异大,临床上需基于血药浓度进行个体化给药,提高疗效,减少不良反应。
英文摘要:
      ABSTRACT Objective: To explore the guiding role of blood concentration monitoring (TDM) for valproate (VPA) in the treatment of epilepsy, and provide reference for the clinical rational use. Methods: Totally 384 epilepsy patients treated with VPA alone were collected between August 2016 and November 2017 in our hospital. The serum concentrations of VPA were determined by HPLC. The relationship was analyzed between TDM and the efficacy and safety. The correlation between TDM and factors(age, dose, sex and dosage form)was assessed using binary logistic regression. Results: Among the 384 patients,272 (70.83%) ones were with an effective range of blood (50 100 μg·ml-1). The clinical efficacy within the range of effective blood concentration (50 100 μg·ml-1) and that with the plasma concentration above 100 μg·ml-1were both significantly higher than that with the plasma concentration below 50 μg·ml-1(P<0.01). The incidence of adverse reactions with the range above 100 μg·ml-1 was significantly higher than that with the range below 50 μg·ml-1 and within the range of 50 100 μg·ml-1. Logistic regression analysis showed that dose and age had significant effect on the blood concentration(P<0.05). Conclusion:The individual difference of VPA is obvious, therefore, VPA should be used in clinic based on TDM to improve the clinical effect and reduce the adverse reactions.
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