丙戊酸钠血药浓度监测对治疗儿童癫痫的临床意义

目的:分析评价治疗药物监测(TDM)对丙戊酸钠(VPA)治疗儿童癫痫的临床意义。方法:采用高效液相色谱法检测丙戊酸钠血药浓度,统计分析血药浓度与临床疗效、剂量、合用药物等因素的相关性。统计学处理采用SPSS 11.5软件。结果:在2 002例次儿童癫痫患者的丙戊酸钠血药浓度监测结果中,血药浓度在50～100μg.mL-1范围内1 185例(59.19%),<50μg.mL-1 538例(26.87%),>100μg.mL-1 279例(13.94%);丙戊酸钠血药浓度与临床疗效、不良反应及年龄密切相关,其他抗癫痫药可能降低丙戊酸钠血药浓度而影响疗效。结论:丙戊酸血药浓度个体差异大,且受药物间相互作用等多种因素影响,临床为实现个体化用药,应常规监测血药浓度。

Clinical significance of therapeutic drug monitoring of sodium valpoate in epileptic children

OBJECTIVE To evaluate the clinical significance of therapeutic drug monitoring(TDM) of sodium valproate(VPA) in the treatment of epileptic children.METHODS Serum VPA concentration was determined by high performance liquid chromatography(HPLC).The correlation between serum drug concentration and the clinical efficacy,the dosage,and combination drugs was analyzed.The data were retrospectively analyzed by SPSS 11.5 program.RESULTS By analyzing the TDM data of sodium valproate in 2002 case-times,1 185 case-times(59.19%) were within the effective serum concention(50-100 μg·mL-1),538 case-times(26.87%) were less then 50 μg·mL-1 and 279 case-times(13.94%) were higher then 100 μg·mL-1.Serum VPA concentration was closely correlated with therapeutic effect,adverse reaction and age.Other antiepileptic drugs may reduce the plasma concentration of valproate and interfere with the therapeutic effect.CONCLUSION Serum concentrations of sodium valproate varied greatly in epileptic children,which were affected by multi-factors such as drug interaction.For the realization of individual administration,the blood drug concentration should be monitored routinely.