地高辛血浓度监测及其影响因素分析

目的: 通过对190例患者地高辛血药浓度监测,分析影响地高辛血浓度的因素,制订合理给药方案,使地高辛用药安全、有效.方法: 使用荧光偏振免疫法监测地高辛血浓度,并统计分析年龄、疾病、合并用药等因素对地高辛血浓度的影响.结果: 年龄老化及疾病状态中肾功能不全、糖尿病和合并应用胺碘酮、排钾利尿药对地高辛血浓度有显著影响(P<0.05).肝功能及合用ACEI、保钾利尿药、钙离子拮抗药对地高辛血浓度无显著影响(P>0.05);结论: 对地高辛进行血药浓度监测具有非常重要的意义.     

北京大学第一医院地高辛血药浓度监测与影响因素分析

目的分析地高辛血药浓度（SDC）的影响因素。方法用系统查询方法汇总北京大学第一医院2014年1月至12月住院患者的地高辛血药浓度监测值。用回顾性调查方法对心血管科室应用地高辛需要治疗药物监测（TDM）的住院患者的用药剂量、年龄、性别、TDM值、肌酸酐清除率（Cr Cl）、电解质、合并用药情况等进行统计和分析。结果进行TDM的住院患者中,SDC<0.5 ng·mL^-1的约占46.0%,0.5⁰.8 ng·mL^-1的约占24.1%,0.8².0 ng·mL^-1的约占25.7%;>2.0 ng·mL^-1的约占4.2%。年龄（<65岁）、Cr Cl(<30 mL·min^-1)、合并使用抗菌药物、合并使用硝酸酯类药物等对地高辛血药浓度有显著影响（P<0.05）。结论北京大学第一医院的地高辛使用基本合理,但SDC值总体偏低。在地高辛的使用过程中应注意根据患者年龄、肌酸酐清除率和合并用药情况对剂量做适当调整,争取做到个体化用药。     

我院2011-2012年164例次地高辛血药监测浓度回顾性分析

目的:监测地高辛血药浓度,为临床安全、有效、合理使用地高辛提供参考依据。方法:采用均相酶扩大免疫分析法,对2011-2012年我院164例次地高辛血药浓度进行监测。回顾性分析年龄、性别、病理状态、服药剂量、频次以及联合用药对地高辛血药浓度的影响。结果:监测数据在一般参考治疗浓度范围内占59.1%,平均血药浓度为(1.22±0.42)ng/ml,达到中毒浓度者占32.9%。年龄的增长、肾功能的减退、日剂量增加均可升高地高辛血药浓度,女性患者的血药浓度比男性患者略高,合并用药与地高辛血药浓度也有一定的相关性。结论:地高辛血药浓度的个体差异性较大,应结合患者生理病理、用药情况、血药浓度监测数据,综合评估地高辛药物浓度与其临床疗效的关系,制订个体化的给药方案,切实保证临床用药的合理性、安全性、有效性。     

我院地高辛血药浓度监测7年回顾性分析

目的通过对我院1995～2001年地高辛血药浓度监测结果进行回顾性的统计分析,进一步提高我院临床用药水平.方法采用荧光偏振免疫法(FPIA)测定地高辛血药浓度,使用spss10.0版统计软件包对数据进行统计.结果性别对地高辛血药浓度无显著性影响(P＞0.05);年龄对地高辛血药浓度有显著性影响(P＜0.05).结论地高辛血药浓度监测能为临床实行最佳个体化给药提供可靠的依据.     

我院2013年127例次地高辛血药浓度监测回顾性研究分析

目的:为临床安全、有效、合理使用地高辛提供参考依据。方法:对我院2013年127例次地高辛血药浓度资料进行回顾性分析,并分析年龄、性别、日计量以及肾功能对地高辛血药浓度的影响。结果:多数患者(65.4%)地高辛血药浓度范围在一般参考范围内;年龄的增长、肾功能的减退、日剂量增加均可升高地高辛血药浓度,女性患者的浓度比男性患者略高,合并用药对地高辛血药浓度也有一定的相关性。结论:地高辛的血药浓度监测能较好的反映其临床疗效,但监测结果应综合考虑各方面因素,实施个体化给药,保证用药安全有效。     

我院101例地高辛中毒临床相关因素分析

目的:探讨导致地高辛中毒浓度的因素,为临床安全、有效、合理使用强心苷类药物提供参考。方法:采用微粒酶免疫测定法测定地高辛的血药浓度,对达地高辛中毒的101例患者病历进行分析。结果:60岁以上患者的血药浓度显著高于60岁以下的患者;随着给药剂量的增加,患者血药浓度增加;多数患者伴有电解质紊乱、高血压、肾功能不全、心功能不全、糖尿病、甲状腺功能减退、慢性阻塞性肺疾病,其地高辛的平均血药浓度分别为(2.87±0.72)、(2.80±0.69)、(2.80±0.64)、(2.75±0.62)、(2.69±0.62)、(2.57±0.27)、(2.54±0.56)ng/ml,合并以上疾病种类越多,对地高辛浓度影响越大;与硝苯地平、去乙酰毛花苷、呋塞米、胺碘酮、螺内酯、氢氯噻嗪、伏立康唑、托拉塞米合并用药时,地高辛平均血药浓度分别为(3.17±0.82)、(3.06±0.68)、(2.86±0.71)、(2.80±0.62)、(2.79±0.65)、(2.57±0.46)、2.41、2.12 ng/ml。结论:年龄对地高辛血药浓度有显著影响,随着年龄增大,地高辛血药浓度呈增高的趋势。除此之外,给药剂量和各种病理、生理状态以及合并用药等均对地高辛血药浓度有影响。     

我院地高辛血药浓度监测7年回顾性分析

目的　通过对我院 1995～ 2 0 0 1年地高辛血药浓度监测结果进行回顾性的统计分析 ,进一步提高我院临床用药水平。方法　采用荧光偏振免疫法 (FPIA)测定地高辛血药浓度 ,使用spss10 .0版统计软件包对数据进行统计。 结果　性别对地高辛血药浓度无显著性影响 (P >0 .0 5 ) ;年龄对地高辛血药浓度有显著性影响 (P <0 .0 5 )。结论　地高辛血药浓度监测能为临床实行最佳个体化给药提供可靠的依据     

婴儿口服地高辛醑剂后血药浓度监测结果分析

目的 探讨婴儿口服地高辛醑剂后血药浓度与临床疗效、给药剂量、合并用药情况、性别、年龄和体重的相关性.方法 查阅广东省人民医院2005 ～2009年口服地高辛醑剂的婴儿病历,记录疗效、用药情况、性别、体重、年龄、血药浓度监测结果等,用统计软件SPSS 13.0进行分析.结果 415例婴儿口服地高辛醑剂血药浓度测定值在治疗浓度0.8～2.2 ng/ml的共270例,占65.1％;低于治疗浓度范围下限(＜0.8 ng/ml)的共107例,占25.8％;高于治疗浓度范围上限(＞2.2 ng/ml)的共48例,占11.6％.婴儿地高辛血药浓度值与性别不存在明显相关性,但与给药剂量、年龄、体重、合并用药和具体病情有关.结论 地高辛血药浓度受个体因素与具体病情影响,药物剂量的制订和调整,应考虑可能影响地高辛血药浓度的各种因素,结合婴儿自身情况来决定最佳给药方案.     

口服地高辛的药代动力学影响因素的研究进展

地高辛是临床上治疗充血性心力衰竭(congestive heart failure,CHF)的主要药物。由于其安全范围窄,个体差异大,用药干扰因素影响较大,目前在临床应用过程中常对其血清浓度进行检测。患者性别、年龄、特殊病/生理状态以及合用药物等是影响血清地高辛浓度的主要因素。在诸多因素中,合并用药所带来的问题最多。临床应用地高辛时,应关注可影响其血药浓度的各种因素,做到安全合理用药。     

拉莫三嗪在双相情感障碍治疗中剂量校正浓度影响因素分析

目的： 研究拉莫三嗪在双相情感障碍治疗中剂量校正浓度（C/D）的影响因素,为其个体化用药提供参考。方法： 回顾性收集广州医科大学附属脑科医院2019-2020年拉莫三嗪血药浓度监测数据及139例患者统计学资料,考察年龄、性别、合并疾病及合并用药对稳态谷浓度及C/D的影响。结果： 患者拉莫三嗪血药浓度均值为（4.64±3.37）μg·mL^-1,平均日剂量为（142.35±81.66）mg,患者的C/D均值为（36.06±22.97）μg·mL^-1·g^-1·d,无合并用药患者与合并丙戊酸用药患者血药浓度分别为（3.2±2.19）,（6.42±3.70）μg·mL^-1,C/D分别为（24.76±14.76）,（50.31±23.16）μg·mL^-1·g^-1·d。合并丙戊酸患者组的C/D明显大于无合并用药患者组（P<0.001）。年龄、性别、合并疾病对血药浓度和C/D无显著影响。结论： 合并丙戊酸用药可显著增加拉莫三嗪剂量校正后血药浓度,建议合并丙戊酸用药患者可实施拉莫三嗪剂量减半,同时密切监测拉莫三嗪血药浓度,减少不良反应的发生。     

一线抗癫癎药物血药浓度监测结果分析

目的:对一线抗癫癎药物血药浓度监测结果进行回顾性分析,指导临床合理用药。方法:对801例服用一线抗癫癎药物病人的血药浓度进行分类汇总,并对结果进行统计学分析。结果:各药在有效血药浓度范围内的病例百分率差异显著(P<0.01),分别为丙戊酸钠(VPA)75.2%、苯巴比妥(PB)67.3%、卡马西平(CBZ)53.1%、苯妥英钠(PHT)20.8%。VPA使用率最高,为60.5%,其血药浓度存在性别差异(P<0.01)。CBZ血药浓度存在年龄差异(P<0.01)。多药联用血药浓度升高的病例增加(P<0.01),以PHT/CBZ方案最为突出。CBZ/VPA、PB/VPA方案在控制率、安全性方面比较好。结论:血药浓度监测对癫癎治疗具有极其重要的临床意义。     

慢性肾脏病患者血清白细胞介素-2水平与病情及相关病变的临床研究

目的探讨慢性肾脏病(CKD)患者血清白细胞介素-2(IL-2)水平及临床意义。方法按照NKF-K/DOQI标准,采用酶联免疫法对CKD患者61例和健康对照组(n=25例)测定血清IL-2含量,并检测相关临床指标,分析血清IL-2水平与肾功能、心血管病变及其他临床资料的关系。结果CKD组患者血清IL-2含量较健康对照组显著升高(P<0.05),肾功能3、4、5级患者血清IL-2水平较肾功能1、2级显著升高(P均<0.05);相关分析显示CKD患者血清IL-2水平与血肌酐呈显著正相关(r= 0.412,P<0.05),与内生肌酐清除率呈显著负相关(r=-0.326,P<0.05)。心血管病变组血清IL-2水平显著高于无心血管病变组(P<0.01),高血清IL-2组心血管病变发生率显著高于正常血清IL-2组(P<0.01)。41例肾功能2～5级的CKD患者血清IL- 2水平与三酰甘油、低密度脂蛋白胆固醇、磷呈显著正相关(P<0.05),与血钙呈显著负相关(P<0.01),与年龄、病程、血压、总胆固醇、高密度脂蛋白胆固醇、血红蛋白、清蛋白无显著相关(P>0.05);回归分析显示血清IL-2水平依次与内生肌酐清除率、血钙和三酰甘油关系最为密切。结论CKD患者血清IL-2水平升高,可能与肾功能减退时严重代谢紊乱引起的T细胞活化有关。IL-2升高本身可能作为损伤因子,参与肾功能恶化,并与心血管病变的发生可能有关。     

Hyponatraemia in very old nonhospitalised people: association with drug use

OBJECTIVE: Hyponatraemia is one of the major problems in geriatric inpatients. However, in nonhospitalised elderly, the preponderance of hyponatraemia and the importance of the effect of drug intake on serum sodium concentrations are little known. This study investigated the prevalence of hyponatraemia in very old nonhospitalised people, controlling for factors that may induce hyponatraemia (especially drug use). METHODS: Data on serum sodium concentration, health and drug use were retrieved for 185 persons aged 92 to 93 years (the 1905 cohort) and 147 persons aged 100 years (the centenarian cohort) participating in two major population-based studies of elderly people in Denmark. Data were analysed by comparing median serum sodium concentrations between users and nonusers of various drugs after controlling for the influence of age, sex, cancer, heart failure, hypothyroidism, renal failure and smoking. Furthermore, the preponderance of drug use in the patients with clinically relevant hyponatraemia was compared with that in persons with normal serum sodium concentrations. RESULTS: Median serum sodium concentration was 140 mmol/L for the centenarians and 141 mmol/L for the 1905 cohort. In total, 19 persons had hyponatraemia (serum sodium concentration < or =134 mmol/L). There was no association between median serum sodium concentration and any of the above-mentioned diseases, or sex or smoking. Of the drugs generally known to cause hyponatraemia, only omeprazole and oral antidiabetic agents were associated with significantly lower median serum sodium concentrations (difference 3 mmol/L). Use of thiazide diuretics was significantly more common than expected in persons with hyponatraemia compared with persons with a normal serum sodium concentration (7 of 19 vs 46 of 270 individuals). Furthermore, the results suggested that digoxin and lactulose might be associated with a lowered median serum sodium concentration. CONCLUSION: This study demonstrates that severe hyponatraemia was rarely seen in a population-based sample of very old persons and that drugs have only a limited influence on serum sodium concentration. The only drug class associated with clinically relevant hyponatraemia was thiazide diuretics, which were used by significantly more persons with hyponatraemia. Furthermore, this study suggests that digoxin and lactulose use is associated with lower serum sodium concentrations in the elderly.     

儿童肺炎支原体感染相关喘息临床治疗研究

[摘要]目的：探讨儿童肺炎支原体（MP）感染相关喘息的临床特征及治疗，进一步为临床诊治MP感染喘息儿童提供参考。方法：选取2岁以上MP感染及非感染喘息患儿各180例，MP感染组加用阿奇霉素治疗，所有随访病例急性发作时选用支气管扩张剂及布地奈德雾化治疗。两组病例按选用长期控制的药物不同分为三组（n=60）：即孟鲁司特组、孟鲁司特组+ICS组、对照组，比较治疗前和治疗6月后的临床指标。结果：（1）MP感染患儿：孟鲁司特组与对照组治疗后FeNO和EOS检测阳性病例数比较差异有统计学意义（P<0.05）；孟鲁司特+ICS组与对照组治疗后急性发作、肺部体征阳性例数、FeNO、IgE、EOS、过敏原、肺功能阳性例数比较差异有统计学意义（P<0.05）；孟鲁司特+ICS组与孟鲁司特组治疗后急性发作、肺部体征、FeNO检测阳性病例数比较差异有统计学意义（P<0.05）。（2）非MP感染患儿：孟鲁司特组与对照组治疗后肺功能检测阳性病例数比较差异有统计学意义（P<0.05）；孟鲁司特+ICS组与对照组治疗后急性发作、肺部体征阳性例数、FeNO、IgE、EOS、肺功能阳性例数比较差异有统计学意义（P<0.05）；孟鲁司特+ICS组与孟鲁司特组治疗后肺部体征阳性例数比较差异有统计学意义（P<0.05）。结论：目前常用的孟鲁司特或孟鲁司特+ICS的治疗方案对MP感染诱发喘息的治疗是有效的，孟鲁司特+ICS的联合治疗对MP感染后诱发喘息患儿治疗效果优于单用孟鲁司特。今后尚需进一步扩大样本量进行临床长期随访研究，以期能进一步明确MP感染导致儿童哮喘的发生机制以及对哮喘儿童的长期影响。     

利培酮和齐拉西酮对精神分裂症患者血浆细胞因子的影响

目的:研究抗精神病药对精神分裂症患者细胞因子的影响。方法:符合ICD-10精神分裂症诊断的60名患者,随机分为利培酮组(给予利培酮治疗)和齐拉西酮组(给于齐拉西酮治疗),并以健康对照组比较,对患者在治疗前及治疗8周后测量血浆IL-2、IL-6及TNF-α水平,并对患者进行PANSS量表评定。结果:两组患者治疗前后血浆IL-2、IL-6及TNF-α水平与对照组比较,差异有统计学意义(P0.05)。两组患者治疗后血浆IL-2、IL-6及TNF-α水平较治疗前降低,差异有统计学意义(P0.05)。治疗前IL-2水平与PANSS量表阳性症状评分呈正相关(r=0.54,P0.05)治疗后TNF-α与阴性症状分呈显著正相关(r=0.41,P0.05)。结论:精神分裂症患者存在免疫功能异常,利培酮和齐拉西酮可以降低精神分裂症患者细胞因子水平。细胞因子水平与精神病理存在一定相关性。     

Evaluation of two prediction models for digoxin dosing

The relationship between the digoxin elimination parameter (A%) and creatinine clearance (CL_Cr) was determined, from blood level data of 160 hospital patients receiving digoxin tablets. The linear regression equation obtained, which varied only slightly from that reported by Jelliffe previously, was used to predict serum digoxin concentrations in 140 patients of four age groups (50–60, 60–70, 70–80 and 80–90 years). The predictions made were found to be less biased and more precise, irrespective of the age of the patients, than those produced using another predictive method known as Dobbs method. However, correlation coefficients of predicted versus measured serum digoxin concentrations for each method did not differ significantly and frequency distribution analyses of prediction errors gave poor results (up to 63% only). Therefore, neither method can be considered to be superior to the other nor can they be said to ensure accurate predictions of serum digoxin concentrations.     

抗结核药物对乙肝病毒感染肺结核患者发生肝损害的临床分析

目的：分析抗结核药物对乙肝病毒感染的肺结核患者发生肝损害的临床情况。方法61例乙肝病毒标记物阳性的肺结核患者（观察组）和64例乙肝病毒标记物阴性的肺结核患者（对照组）均采取相同抗结核药物治疗,比较两组患者肝功能损害发生率、治疗前后肝功能指标（ALT、AST、TBIL）变化和肝功能损害出现时间及恢复时间。结果观察组肝功能损害发生率明显高于对照组（P<0.05）;观察组治疗后肝功能指标（ALT、AST、TBIL）较对照组明显升高（P<0.05）;观察组肝功能损害出现时间较早,而恢复时间较对照组晚（P<0.05）。结论抗结核药物对乙肝病毒感染的肺结核患者造成明显的肝损害,所以抗结核药物治疗前应检查乙肝病毒标记物,治疗过程中应用保肝药物,并要经常检查肝功能,做到早发现、早诊断、早治疗,提高肺结核的治愈率。     

The effect of everyday exercise on steady state digoxin concentrations

The purpose of this study was to evaluate the effect of 1 hour of everyday exercise (walking at patient's own pace) on serum digoxin concentrations. Nine white male subjects (ages 58-74) who had been taking the same digoxin dose for greater than 1 month participated. There were three continuous phases: 1 hour of rest, 1 hour of exercise, and a final hour of rest. Serum digoxin concentrations were drawn every 20 minutes. During the first rest period, serum digoxin concentrations rose 30% from the first concentration drawn in the study. After 1 hour of exercise, serum digoxin concentrations fell 26.8% from the last concentration of the first rest period. At the end of the second hour of rest, serum digoxin concentrations increased by 36.6% from the last concentration. Repeated measures analysis of variance demonstrated a significant (P less than .01) change in serum digoxin concentrations. Significant (P less than .01) differences were found between sampling times 0 and 60, 60 and 80, 60 and 100, 60 and 120 and 180 minutes using a paired t-test with Bonferroni correction. A weak correlation (r = 0.74, r2 = 0.55) between percent change in concentrations and age during the exercise phase was found, but there was no correlation between the percent change in concentrations and age during the two immobilization phases. Because significant changes in concentrations occurred during each phase of the study, we conclude that the influence of everyday exercise should be taken into account when interpreting serum digoxin concentrations.(ABSTRACT TRUNCATED AT 250 WORDS)     

Endogenous digoxin-like immunoreactivity in elderly patients with normal serum creatinine concentrations

The effect of digoxin-like immunoreactive substance (DLIS) on serum digoxin determinations in elderly patients with normal serum creatinine concentrations was studied. Patients in the study group were over 70 years of age; the control population was under 55 years of age. All patients had serum creatinine concentrations of less than or equal to 1.5 mg/dL. Apparent digoxin content of serum samples from patients receiving digoxin and from patients in each age group who were not receiving digoxin was determined in duplicate by each of two radioimmunoassays: RIANEN (New England Nuclear), which detects DLIS, and Immophase (Corning Medical and Scientific), which is far less cross-reactive with DLIS. Results from the patients under 55 years of age were analyzed for inherent bias between the assay methods. In patients over 70 years of age, concentrations of DLIS (differences between serum digoxin concentrations measured by RIANEN and Immophase) were compared with creatinine clearance values. No DLIS was detected in sera of patients who had not received digoxin. For patients who received digoxin, nearly all apparent digoxin concentrations were within the usual therapeutic range. For patients without liver or renal failure who received digoxin, no significant difference in digoxin concentrations was observed between the RIANEN and Immophase assays in either the young (n = 17) or elderly (n = 26) patients. There was no significant increase in the difference between the RIANEN and Immophase results with decreasing creatinine clearance. In the elderly patients with normal serum creatinine concentrations, there was no evidence that measurement of serum digoxin concentration using the RIANEN and Immophase assays was compromised by DLIS.