充血性心力衰竭患者地高辛临床药动学及影响因素研究

 目的：研究充血性心力衰竭病人地高辛(DG)临床药动学及影响因素。方法：用RIA法测定DG血药浓度。用Bayesian一点法拟合DG个体药动学参数及给药方案。用Minitab软件进行统计学分析。结果：CrCl为(54.2±18.2)ml·min^-1，Cl为(73.4±27.5)ml·h^-1·kg-1,V_d为(6.95±1.07)L·kg^-1,t_1/2为(73.7±23.5)h,K为(0.0104±0.0033)h^-1；各参数波动范围大，变异均在30%以上(V_d除外)。年龄与CrCl，Cl和V_d存在极显著性负相关存在高度的正相关(P<0.001)，尤其是V_d,r=0.913。不同年龄段CHF患者的CrCl较正常人减少约25ml·min^-1。结论：随着年龄的增长，肾功能逐渐下降，DG的CL和V_d也随之相应减少。CrCl和V_d的高相关性与心功能不全累及肾功能损害和外周血管的慢性收缩有关，使DG分布和排泄发生障碍。CHF患者的肾损害也随心功能恶化而加剧。

Digoxin clinical pharmacokinetics and its influence factors in patients with congestive heart failure

OBJECTIVE: To study clinical pharmacokinetics of digoxin and its influence factors in patients with congestive heart failure. METHOD: Radioimmunoassay was used to measure serum digoxin concentration, the method of one point of Bayesian to calculate digoxin clinical pharmacokinetics parameters as well as dosage regimens, and the minitab software to analyse data statistically. RESULTS: CrCl was (54.2±18.2)mlmin-1, Cl (73.4±27.5)mlh-1kg-1, Vd (6.95±1.07)Lkg-1, t1/2(73.7±23.5)h, K(0.010 4±0.003 3)h-1. Every parameter varied greatly, and their variations were all above 30% except Vd. There was a very significantly negative correlation between age and any of CrCl, Cl and Vd (P＜0.001), and a strong positive correlation between CrCl and Cl or Vd (P＜0.001), especially Vd (r=0.913). CrCl was approximately 25 mlmin-1 less than normal persons at different age of CHF patients. CONCLUSION: Kidney function droped gradually, Cl and Vd also lessened with age. A strong correlation of CrCl and Vd involved heart function failure, kidney function damaged and the slow contracting external blood vessels resisted the distribution and eliminaton of digoxin. Kidney function damage of CHF patients aggravated with the worsening of heart function.