2种抗癫痫药血药浓度监测1490例次结果分析

目的分析癫痫患者丙戊酸钠和卡马西平血药浓度监测结果,为临床合理用药提供参考。方法采用荧光偏振免疫法测定癫痫患者体内丙戊酸钠和卡马西平血药浓度,对1 490例次血药浓度监测结果进行比较分析,并观察其临床疗效和不良反应。结果 1 234例次丙戊酸钠血药浓度监测中,血药浓度<50μg.mL-1的占30.31%,控制癫痫发作的有效率为44.53%;在50~100μg.mL-1的占57.62%,有效率为89.17%;>100μg.mL-1的占9.48%,有效率为76.92%;183例次卡马西平血药浓度监测中,血药浓度<4μg.mL-1的占15.30%,控制癫痫发作的有效率为46.43%;在4~12μg.mL-1的占81.97%,有效率为66.67%;>12μg.mL-1占2.73%,有效率为100%;73例次联合用药中,只有22例次在有效血药浓度范围内。结论抗癫痫药物血药浓度个体差异大,血药浓度监测能为临床合理用药提供重要依据,对提高癫痫治疗的安全性和有效性具有重要指导意义。

Serum concentration of 2 anti-epilepsy drugs in 1490 case-times

Objective To analyse the serum concentration of sodium valproate and carbamazepine in patients with epilepsy and to provide evidence for rational use of the drugs.Methods Fluorescence polarization immunoassay was used to determine the serum concentration of sodium valproate and carbamazepine.Results The serum concentration of sodium valproate that was lower than 50 μg·mL-1 accounted for 30.31% with the effective rate of 44.53% for epilepsy,between 50 and 100 μg·mL-1 accounted for 57.62% with effective rate of 89.17%,and higher than 100 μg·mL-1accounted for 9.48% with effective rate of 76.92%.The serum concentration of carbamazepine that was lower than 4 μg·mL-1 accounted for 15.30% with effective rate of 46.43%,between 4 and 12 μg·mL-1 accounted for 81.97% with effective rate of 66.67%,higher than 12 μg·mL-1 accounted for 2.73% with effective rate of 100%.Twenty-two case-times were in the range of effective serum concentrations out of the 73 case-times of anti-epileptic drug combinations.Conclusion There is great individual difference among patients in serum concentration of anti-epilepsy drugs.Monitoring the serum concentrations of anti-epileptic drugs may provide evidence for the rational administration and plays an important role in the treatment of epilepsy.