摘要
目的探讨癫患儿使用丙戊酸钠缓释片(DK)血药质量浓度监测、取血时间的选择以及对测定结果的评价。方法采用荧光偏振免疫法,对271例服用DK患儿、155例服用丙戊酸钠糖浆(VPASyr)患儿达稳态后进行血药质量浓度测定。分为DK1次/d服用组(DKqd组,126例),DK每晚1次服用组[DKqn组,次日晨即取血测定(26例)],DK每12小时1次服用组(DKq12h组,119例),VPASyrq12h组(155例)。计算各组血药质量浓度低于、达到以及高于丙戊酸治疗窗(50～100mg/L)的比例。对4组的监测结果以及用药剂量行t检验。结果DKqd组血药谷水平为(73.09±19.91)mg/L,与DKqn组的血药质量浓度[(94.94±25.44)mg/L]比较有显著性差异(P<0.01)。DKq12h组血药谷水平为(96.67±22.02)mg/L,明显高于DKqd组(P<0.01)。VPASyrq12h组血药谷水平为(58.92±23.60)mg/L,明显低于DKqd组(P<0.01)。DKqd组血药谷水平达治疗窗的比例为77.8%,高于治疗窗比例为9.5%,低于治疗窗比例为12.7%;DKq12h组血药谷浓度达治疗窗的比例为58.0%,高于治疗窗的比例达40.3%,低于治疗窗比例为1.7%。VPASyrq12h组血药谷浓度达治疗窗比例为58.1%,高于治疗窗比例为5.8%,低于治疗窗比例达36.1%。DKqd组给药剂量为(18.54±5.50)mg/(kg.d)(n=27),明显低于DKq12h组[(23.39±6.50)mg/(kg.d),n=36](P<0.01),VPASyrq12h组给药剂量为(24.81±5.98)mg/(kg.d)(n=155),与DKq12h组无显著性差异(P>0.05)。结论服用DKqn时,血药质量浓度监测取血时间应为次日晚服药前。DKq12h服用血药谷水平偏高,其适宜的谷水平范围可能与普通剂型不同。
Objective To explore the blood drug concentration monitoring of sustained - release valproate （DK） in children with epilepsy, focusing on the selection of sampling time and evaluation of the results. Methods Two hundred and seventy - one children taking DK and 155 children taking sodium valproate syrup （VPA Syr） were involved and their serum were taken when achieved steady state to determine the valproic acid level using fluorescence polarization immunoassay. They were divided into 4 groups, which were DK taken once daily group （ DK qd group, 126 children）, DK taken once daily at night and sampled on morning group （ DK qn group,26 children） , DK taken every 12 h group （DK q12 h group, 119 children）, VPA Syr q12 h group（ 155 children）. Determine the proportion of the blood drug concentration of each group below,ithin and above the therapeutic range for valproate（50 - 100 mg/L） were determined. The data were analyzed by t test. Results The Cmin of DK qd group were （73.09 ± 19.91 ） mg/L, significantly lower from the serum concentration of DK qn and sampled on morning group [ （94.94 ± 25.44） mg/L] （P 〈 0.01 ）. The Cmin of DK q12 h group [ （96.67 ± 22.02） mg/L] were significantly higher than that of DK qd group （P 〈 0.01 ）. The Cmin of VPA Syr q12 h group [ （58.92 ± 23.60） mg/L] were significantly lower than that of DK qd group （P 〈 0.01 ）. The proportion of Cmin of DK qd group in the therapeutic range was 77.8% , while above and below the therapeutic range was 9.5% and 12.7% ,respectively. The proportion of Cmin of DK q12 h group in the therapeutic range was 58.0% , while above and below the therapeutic range was 40.3% and 1.7% ,respectively. The proportion of Cmin of VPA Syr q12 h group in the therapeutic range was 58.1% , while above and below the therapeutic range was 5.8%and 36.1% ,respectively. The dose of DK qd group was （18.54 ±5.50） mg/ （ kg · d） （ n = 27）, significantly lower than that of DK q12 h group [ （ 23.39 ± 6.50） mg/（ kg · d）, n = 36 ] （ P 〈 0.01 ）. The dose of VPA Syr q12 h was（ 24.81 ± 5.98） rag/（ kg · d） （ n = 155 ）, the difference was not significant compared with that of DK q12 h group（P 〉 0.05）. Conclusions DK qn should sampled at night before the night dose. The Cmin of DK q12 h was higher according to the therapeutic range, it＇s favorable range still needs clinical oraetice.
出处
《实用儿科临床杂志》
CAS
CSCD
北大核心
2009年第12期940-942,共3页
Journal of Applied Clinical Pediatrics
关键词
丙戊酸钠
缓释片
血药质量浓度
监测
valproate sodium
sustained - release tablet
blood drug concentration
monitoring
