用群体药物动力学方法分析大剂量甲氨蝶呤持续静滴时间和解救开始时间

目的：探讨急性淋巴系恶性肿瘤患儿的大剂量甲氨蝶呤（HDMTX）持续静滴时间及四氢叶酸钙（LCV）解救的开始时间。方法：27例患儿典接受三种HDMTX方案治疗99例次,1g／m^2静滴36h、3g／m^2静滴24h和5g/m^2静滴24h分别为14、58和27例次。荧光偏振免疫法（FPIA）测定MTX血浓度,NONMEM软件进行模型拟合和群体药动学参数的计算,计算不同时间的MTX浓度。结果：HDMTX静滴为二室模型分布．三种HDMTX方案的MTX血药浓度达到稳态的时间为8-11h。MTX由分布相转入消除相的时间为MTX静滴结束后的12h左右（10-17．4h）。结论：HDMTX的持续静滴时间不应少于8～11h,LCV开始解救的中位时间为MTX静滴结束后的12h．最晚不应超过MTX静滴结束后的17．5h。     

Establishment of norvancomycin fluorescence polarization immunoassay for therapeutic drug monitoring

To establish a rapid and simple fluorescence polarization immunoassay method for determination of norvancomycin serum concentration, we collected 300 serum samples from the patients receiving norvancomycin in the hospitals localized in Shanghai, China. The drug concentrations were measured by the established HPLC method and FPIA with vancomycin kit. A FPIA algorithm for the determination of norvancomycin concentration was established according to the correlation between the FPIA and HPLC results. The methods and algorithm were validated in another 70 clinical samples. HPLC determination showed a good linear correlation within the range of 0.5-100?mg?l(-1) of norvancomycin concentrations. The method was validated via extraction recovery, intra- and inter-day methodological recovery and stability of norvancomycin in serum. Correlation analysis between the measurements of HPLC and FPIA in 300 serum samples gave the linear regression equation: (concentration by HPLC)=0.760 × (concentration by FPIA)-0.577 (P<0.001, R(2)=0.982). An algorithm was derived from this correlation for measuring the serum norvancomycin concentrations with FPIA. When it was validated in additional 70 serum samples from patients, 'FPIA algorithm' showed good accuracy versus HPLC: 'FPIA algorithm'=0.93 (HPLC)+0.63, R(2)=0.962, and 94.3% of the results from FPIA algorithm fell within the range of -20%/+20% of HPLC. This algorithm developed in this study can be easily used for determination of norvancomycin using TDx analyzer with vancomycin kit indirectly. It may also be useful for norvancomycin therapeutic drug monitoring.     

EMIT和FPIA测定丙戊酸、甲氨喋呤和环孢霉素A血药浓度的比较研究

目的比较均相酶放大免疫分析法(EMIT)和荧光偏振免疫分析法(FPIA)测定丙戊酸(VPA)、甲氨喋呤(MTX)和环孢霉素A(CsA)血药浓度结果,并评价两种测定方法所得结果的相关性。方法收集患者服药后的血样,采用EMIT和FPIA同时测定VPA、MTX和CsA血药浓度;以FPIA测定值为X,以EMIT测定值为Y,进行线性回归,评价其相关性。结果所得线性回归方程如下:YVPA=1.894 1+1.190 3X,r=0.983;YMTX=0.099 24+1.136X,r=0.992;YCsA=1.146 5+0.846 1X,r=0.971。EMIT测定血浆中VPA血药浓度较FPIA高11.2μg.mL 1,EMIT测定MTX血药浓度较FPIA高0.22μmol.L 1,EMIT测定CsA血药浓度较FPIA低20.6 ng.mL 1,差异有统计学意义(P<0.05)。结论 EMIT与FPIA测定VPA、MTX和CsA血药浓度差异具有统计学意义,在治疗药物监测中应予以注意。     

三种检测方法测定甲氨蝶呤血药浓度的比较分析

目的比较高效液相色谱法（HPLC）、荧光偏振免疫分析法（FPIA）和酶增强免疫法（EMIT）监测甲氨蝶呤（MTX）血浆药物浓度的相关性。方法收集接受大剂量甲氨蝶呤化疗后的患者的血液样品,分别用HPLC、FPIA和EMIT法进行测定,考察3种测定方法的相关程度。结果多配对样本Friedman检验提示3种方法间差异有显著性,Wilcoxon检验结果提示HPLC法和FPIA法检测结果之间差异无显著性,EMIT法结果与另外两种方法之间差异有显著性。3种检测方法的的回归分析结果为：Y HPLC=1.00X FPIA＋0.015（r=0.978,P〈0.000 1）;Y HPLC=0.94X EMIT-0.079（r=0.956,P〈0.000 1）;Y FPIA=0.95X EMIT-0.089（r=0.927,P〈0.000 1）。结论 3种甲氨蝶呤检测方法之间还是存在差异,但这种差异是可以预见性的,且可以通过换算消除,临床治疗和研究工作要予以注意。     

比较HPLC和FPIA法测定人血清中卡马西平的血药浓度

目的比较治疗药物监测中高效液相色谱法(HPLC)和荧光偏振免疫法(FPIA)测定血清中卡马西平(CBZ)的浓度。方法收集上海华山医院和北京天坛医院服用CBZ的癫痫患者608例的稳态谷浓度血样,分别用HPLC法和FPIA法进行测定,用回归法和图解法考察2种测定方法的相关程度以及环氧化卡马西平(CBZE)的交叉反应率。结果CBZE能干扰CBZ的测定,CBZ测定值FPIA较HPLC法高4.58% (95%置信区间:-5.7%~17.6%)。CBZE的交叉反应率随CBZE浓度增加而减小。结论 在CBZ治疗药物监测中,对不同测定方法测定差异,应予以关注并作相应调整。     

高效液相色谱法和荧光偏振免疫法测定万古霉素血清浓度的比较

目的:比较高效液相色谱(HPLC)法与荧光偏振免疫(FPIA)法分别测定血清万古霉素浓度的结果,探讨两者的相关性。方法:收集临床检测万古霉素药物浓度的血清43份,分别用HPLC法和FPIA法进行测定,运用配对t检验,Bland-Altman分析和线性回归分析比较2种方法的测定结果。结果:HPLC法和FPIA法测定的万古霉素血清浓度具有良好的相关性, 回归方程为:Y_FPIA=1.103X_HPLC+0.831 5(R²=0.957 2); Bland-Altman评价分析2种方法一致性较好;配对t检验显示2种方法测定结果之间有显著统计学差异(P<0.000 1)。结论:相较于FPIA法,HPLC法测定不受代谢和降解产物干扰,能准确检测血清万古霉素浓度,适合应用于治疗药物监测。     

限进介质-HPLC法与荧光偏振免疫法测定人血浆中卡马西平浓度的比较

目的：建立以限进介质-高效液相色谱（RAM—HPLC）法测定患者血浆中卡马西平（CBZ）浓度的方法,并与荧光偏振免疫（FPIA）法测定结果进行比较。方法：血浆样品离心后,静脉血浆用FPIA法和RAM—HPLC法测定,指端血浆仅用RAM—HPLC法测定。其中,色谱柱为Hisep shielded hydrophobic phase分析柱,流动相为醋酸铵缓冲液-乙腈（88：12）,流速为1．5mL·min^-1,检测波长为280nm,进样量为20μL,柱温为室温。结果：FPIA法测定静脉血浆CBZ的结果与RAM—HPLC法分别测定静脉和指端血浆CBZ的结果有良好的相关性（r分别为0．989、0．995）,但有显著性差异（P〈0．05）;RAM—HPLC法测定静脉和指端血浆CBZ的结果亦有良好相关性（r=0．998）,但无显著性差异（P〉0．05）。结论：RAM—HPLC法和FPIA法均可测定CBZ浓度,FPIA法更适合常规监测,RAM—HPLC法更适合相关研究和特殊病例监测。2种测定方法均不需样品前处理,有良好的重现性。     

Validation of a high-pressure liquid chromatography and fluorescence polarization immunoassay for the determination of methadone in canine plasma

Methadone is a synthetic opiate derivative that possesses analgesic activity. A modified fluorescence polarization immunoassay (FPIA) method and a high-pressure liquid chromatography (HPLC) method with UV detection were compared for measurement of concentrations of methadone in canine plasma following intravenous and oral methadone administration. The mean+/-SD for accuracy (deviation from actual concentration) and precision (coefficient of variation) when methadone-fortified canine plasma was evaluated with the FPIA method were 3.9+/-3.2% and 4.4+/-2.9%, respectively. The accuracy and precision of the HPLC method were 6.2+/-5.2% and 7.7+/-3.9%, respectively. The limit of quantification for the FPIA and HPLC methods were 25 and 20 ng/mL, respectively. The coefficient of determination (r) between FPIA and HPLC analysis was 0.94 when plasma from dogs dosed with methadone was evaluated. FPIA provides a rapid, sensitive, and specific measurement of methadone in canine plasma following oral and intravenous administration.     

银屑病患者甲氨蝶呤的群体药动学研究

目的:研究银屑病患者甲氨蝶呤(MTX)的群体药动学特征,为临床调整个体化用药提供新途径。方法:收集皮肤科50例银屑病患者单剂量静脉滴注MTX后稀疏血药浓度数据137个,采用荧光偏振免疫法(FPIA)测定,应用非线性混合效应模型(NONMEM)程序一步法估算MTX的群体药动学参数,并定量分析患者年龄、性别、体质量、肌酐清除率、尿素氮等因素对MTX药动学参数的影响。结果:按静脉滴注二房室线性开放模型估算的群体药动学参数中央室清除率(CL)、中央室表观分布容积(Vc)、外周室表观分布容积(Vp)及外周室清除率(Q)分别为10.4L·h-1、11.7L、6.61L及2.8L·h-1,其个体间变异ωCL、ωVc、ωVp、ωQ分别为16.8%、2.8%、11.7%及287.9%。且最终回归模型的MTX浓度估算值与实测值具有一致性。效应中尿素氮对Vp的影响具有显著意义(P>0.05),其协变量参数为(尿素氮/4)-0.845。结论:NONMEM法以二室模型群体参数估算的血药浓度值与实测值有良好相关性,此研究结果有助于MTX的临床合理应用。     

Effect of indomethacin on the pharmacokinetics of methotrexate in rabbits.

The interaction between indomethacin (IND) and methotrexate (MTX) was investigated in rabbits. The study was designed so as to evaluate the effect of IND (1 mg h-1) during a continuous MTX infusion (1 x 2 mg kg-1) over 240 min. IND was injected i.v. at hourly intervals after a steady state MTX concentration had been established. Plasma MTX concentration before and after IND did not differ significantly (p greater than 0.05). The elimination half-life (t1/2 beta) calculated during the washout interval (mean +/- SD) was 47 x 4 +/- 21 x 5 min which is close to that calculated in a reference group of rabbits. This excludes the possibility of delayed elimination as responsible for this toxicity. The toxicity of this combination was confirmed despite the absence of significant pharmacokinetic changes. It is possible that the toxic interaction was caused by enhanced cytotoxic effect of MTX.     

A modified fluorescence polarization immunoassay method incorporating fat emulsion (FE-FPIA) to determine cyclosporin A concentrations in rat skin.

We have developed a simple, sensitive and reliable assay procedure for cyclosporin A (CyA), a modified fluorescence polarization immunoassay method incorporating fat emulsion (FE-FPIA), to determine the CyA content in rat skin. The conventional fluorescence polarization immunoassay (FPIA) method for CyA using a commercially available FPIA kit, TDX cyclosporine monoclonal whole blood, was modified. A fat emulsion for intravenous infusion, Intralipos, was incorporated for dissolving the CyA extracted from the skin tissue, and a mixture of MeOH/purified water was used as the sample pretreatment medium instead of the precipitation reagent in the conventional FPIA kit intended for whole blood samples. These modifications enabled us to produce a reliable and the sensitive assay of CyA in skin tissue. The reproducibility (coefficient of variation), detection limit, and assay time for FE-FPIA were below 2%, 25 ng/ml, and about 24 min/24 samples, respectively, and were comparable with those for the whole blood samples determined by the conventional FPIA. Pre-purification of samples required by the HPLC assay is not needed in the FE-FPIA method. The usefulness of the FE-FPIA method in evaluating the topical pharmacokinetics of CyA in skin is discussed.     

Lack of correlation between methotrexate concentrations in serum, saliva and sweat after 24 h methotrexate infusions.

1 Methotrexate (MTX) concentrations were studied in serum, mixed saliva and sweat during and after 24 h continuous MTX infusions (0.5-6 g m-2) in 14 patients with various malignant diseases. 2 The serum-MTX concentrations declined in a biphasic manner, but the MTX elimination in saliva and sweat varied to a much greater extent. 3 Saliva/serum and sweat/serum ratios during the MTX infusion were 2.3% and 0.55% respectively. The ratios had increased significantly 20 and 44 h postinfusion. 4 No correlations were demonstrated between salivary- and serum-MTX concentrations during the MTX infusion or 20 and 44 h later. 5 Markedly delayed renal MTX excretions were demonstrated in two patients. In one of them the salivary MTX elimination was also retarded, whereas this was not seen in the other one. 6 We conclude that measurements of MTX concentrations in mixed saliva cannot substitute for serum-MTX determinations in the monitoring of patients after 24 h MTX infusions.     

儿童急性淋巴细胞白血病化疗中甲氨蝶呤血药浓度监测结果分析

目的评价儿童急性淋巴细胞白血病(ALL)化疗中甲氨蝶呤(MTX)消除的个体差异性,为临床制订合理的解救治疗方案提供依据。方法 81例ALL患儿行大剂量甲氨蝶呤(HDMTX)化疗339次,MTX剂量为3～5 g.m-2,24 h持续静脉滴注。用固相萃取高效液相色谱法测定用药后24,48,72 h血清中MTX浓度。统计各时间点浓度值,并计算变异系数(CV)。用Spearman相关分析考察48,72 h MTX血药浓度的相关性。结果 48,72 h MTX血药浓度变异系数较大,血药浓度呈正相关。结论 MTX在ALL患儿体内的消除情况存在极大的个体差异性,有必要通过血药浓度监测来指导亚叶酸钙(CF)的解救次数和剂量。     

Comparison of high pressure liquid chromatography and fluorescence polarization immunoassay methods in a theophylline pharmacokinetic study

High pressure liquid chromatography (HPLC) and fluorescence polarization immunoassay (FPIA) were compared in a theophylline pharmacokinetic study. Eight healthy subjects received single 600-mg oral doses of two different sustained-release theophylline formulations. Fourteen blood samples were collected over 57 h after each dose, and the serum was analyzed for theophylline using both HPLC and FPIA methods. In comparing the two formulations using HPLC, there was no statistical difference in the area under the curve (AUC), terminal rate constant (k), or time of peak. However, there was a 13% difference in peak theophylline concentration (p less than 0.05). The same statistical conclusions were made for all parameters when using FPIA. When comparing the kinetic parameters determined with each assay, the AUC was 12% greater and the k was 17% smaller with FPIA (p less than 0.05). Orthogonal regression of all serum theophylline concentrations showed that FPIA = 1.04 HPLC + 0.20; r = 0.987, p less than 0.001. Stratification of serum theophylline concentrations into different ranges showed that FPIA overestimated the HPLC results in each range, but the percentage of overestimation was greater at lower concentrations (p less than 0.05). The use of FPIA seems appropriate in comparative studies of theophylline pharmacokinetics; however, the calculated kinetic parameters may differ slightly from those obtained with HPLC.     

多药耐药基因1 C3435T多态性与急性淋巴细胞白血病患儿甲氨蝶呤血清浓度的关系

目的考察多药耐药基因1(MDR1)C3435T多态性与急性淋巴细胞白血病(ALL)患儿甲氨蝶呤(MTX)血清浓度及化疗毒性的相关性。方法收集100例ALL患儿外周血,提取基因组DNA;用PCR-RFLP法,检测MDR1 C3435T基因型;用荧光偏振免疫法(FPIA),测定MTX血清浓度,同时观察化疗的疗效和毒性。结果 CC、CT和TT基因型的分布频率分别为33%,53%,14%;C和T等位基因的分布频率分别为59.5%和40.5%。肝功能异常ALL患儿,其24,42h MTX剂量校正的血清浓度(C/D比值)高于肝功能正常者;携带野生基因型(CC)ALL患儿的24,42 h MTX C/D比值高于突变基因型(CT+TT)携带者;携带野生基因型ALL患儿的未缓解、化疗毒性和排泄延迟发生率,高于突变基因型携带者。由于个体间的变异大,上述差异均无统计学意义(P>0.05)。结论多种因素影响MTX的药代与药效,MDR1 C3435T多态性与ALL患儿的MTX血清浓度和化疗毒性无显著相关关系。     

Evaluation of fluorescence polarization immunoassay for determination of cyclosporin in plasma

The fluorescence polarization immunoassay (FPIA) method for determination of cyclosporin in plasma was evaluated and compared with the high-performance liquid chromatography (HPLC) and the radioimmunoassay (RIA) methods. The coefficients of variation for the within-run and between-run precision were less than 5 and less than 8%, respectively, for samples ranging in concentration from 50 to 600 ng/ml. Recoveries were determined by adding cyclosporin at concentrations from 25 to 1,000 ng/ml to patient plasma; they were, on average, 98.5%. The calibration curve was stable throughout a 10-week study period. There was no clinically significant interference due to hemolysis, icterus, lipemia, or other commonly used drugs. There was considerable variation of the ratio of the FPIA result to the HPLC result, whereas there was a good correlation between the FPIA and the RIA results (r = 0.975, n = 25, y = 1.2x - 36.4), when evaluated using specimens from renal transplant patients receiving cyclosporin orally. It was concluded that the FPIA is an appropriate, rapid method for patient cyclosporin analysis in plasma and serves as a practical alternative to the RIA.     

FPIA法与HPLC法测定苯妥英钠血药浓度的对比

目的比较荧光偏振免疫法（FPIA）与高效液相色谱法（HPLc）测定血浆中苯妥英钠的浓度。方法收集服用苯妥英钠的患者稳态浓度的血浆样品,分别以荧光偏振免疫法和高效液相色谱法进行测定,用回归法考察两种方法测定结果的相关性,比较测定结果。结果2种方法在统计学上无显著性差异,具有良好的相关性（P〉0．05）。以荧光偏振免疫法测定结果（X）与高效液相色谱法测定结果（Y）所作线性回归方程如下：Y=-0．1093＋0．9812x,相关性分析：r=0．9517。结论荧光偏振免疫法与高效液相色谱法测定苯妥英钠血药浓度具有相关性．2种方法均可用于血药浓度的常规监测。     

Comparison of fluorescence polarization immunoassay and high performance liquid chromatography for the quantitative determination of phenytoin, phenobarbitone and carbamazepine in serum

The Abbott TDx fluorescence polarization immunoassay (FPIA) system has been evaluated and compared with well-established high performance liquid chromatography (HPLC) for the determination of three anticonvulsant drugs: phenytoin, phenobarbitone and carbamazepine. These assays were evaluated for precision, calibration curve stability, specificity and accuracy. Within-run precision studies using control samples (n = 15) in the subtherapeutic, therapeutic, and toxic concentrations, resulted in coefficients of variation in the range of 1.79-3.99% (FPIA) and 1.16-2.52% (HPLC), respectively. Between-run precision ranged from 2.32-6.34% for FPIA and from 2.04-3.38% for HPLC. Comparison of 122 patient samples assayed with both methods indicated an extremely good analytical correlation (r = 0.96) for all three comparisons. The FPIA method offers significant advantages in calibration curve stability while maintaining accuracy and precision comparable with those of established HPLC procedures.     

Comparison of high pressure liquid chromatography and fluorescence polarization immunoassay to assess quinidine pharmacokinetics

High pressure liquid chromatography (HPLC) and fluorescence polarization immunoassay (FPIA) were compared in a quinidine pharmacokinetic study. Six healthy male subjects received single oral doses of regular release (RR) quinidine sulfate, sustained release (SR) quinidine bisulfate and the same dose of the SR product with food (SR-F). Serum was collected for 49 h after each dose and analysed for quinidine by HPLC and FPIA. Using HPLC, there were no statistically significant differences between dosing regimens with respect to area under the curve (AUC) or terminal rate constant (K). The RR dose resulted in a higher peak plasma concentration (Cp) and shorter time to peak (Tp) than either of the SR doses (p less than 0.01). Food had no apparent effect on the bioavailability of the SR product. When using FPIA, food administration was found to increase the AUC for the SR product (p less than 0.05) and all three dosage regimens resulted in a different Cp and Tp (p less than 0.001). When comparing all pharmacokinetic parameters determined by each assay, FPIA resulted in a significantly lower K (p less than 0.01). Orthogonal regression of all serum quinidine concentrations showed that FPIA = 0.926 (HPLC) + 0.06 (r = 0.971, p less than 0.001). Analysis of quinidine concentrations in different concentration ranges revealed that FPIA overestimated HPLC for concentrations less than 1 micrograms ml-1 (p less than 0.001) and underestimated HPLC for concentrations greater than 2 micrograms ml-1 (p less than 0.01). Although the use of FPIA is appropriate for quinidine therapeutic drug monitoring, HPLC is the preferred assay method for assessing pharmacokinetic parameters in single dose bioavailability studies.     

比较高效液相色谱法和液质联用法测定化疗患者血浆中甲氨蝶呤浓度的相关性

目的 比较高效液相色谱(HPLC)法和液质联用(LC-MS/MS)法测定人血浆中甲氨蝶呤(MTX)浓度的相关性.方法 收集接受大剂量MTX化疗后的患者的血液样品,分别用HPLC、LC-MS/MS法进行MTX血药浓度测定,通过Wilcoxon检验或配对t检验来比较2种测定方法在不同浓度范围的差异,通过压轴回归分析法建立回...