上呼吸道感染对精神分裂症患者氯氮平血药浓度的影响

目的：分析上呼吸道感染与精神分裂症患者的氯氮平（clozapine，CLZ）血药浓度、不良反应三者的相关性。方法：纳入35例CLZ稳定治疗的精神分裂症伴有上呼吸道感染的住院患者，分别采集感染前后清晨服药前的空腹血，采用HPLC-MS测定CLZ稳态谷浓度。结果：35例患者在感染后CLZ血药浓度有不同程度的升高，基线期平均血药浓度为（481.6±258.0）μg·L^-1，感染期平均血药浓度为（853.8±452.4）μg·L^-1。17例患者发生了CLZ血药浓度升高后的不良反应，其中最多的是精神性不良反应。结论：上呼吸道感染对CLZ血药浓度的升高有一定影响，并导致不良反应的发生。所以住院感染期间CLZ血药浓度的监测是至关重要的，同时应注意剂量的调整，减少不良反应发生的风险。

Effect of upper respiratory tract infection on clozapine concentration in schizophrenic patients

OBJECTIVE To analyze the correlation between upper respiratory tract infection and clozapine (CLZ) plasma concentration and adverse reactions in patients with schizophrenia.METHODS Thirty-five schizophrenic patients with upper respiratory tract infection treated with CLZ were enrolled in this study.Fasting blood samples were collected before and after treatment in the morning.The steady trough concentration of CLZ was determined by HPLC-MS.RESULTS The plasma concentration of CLZ in 35 patients increased to some extent after infection.The mean plasma concentration was (481.6±258.0) μg·L^-1 at baseline and (853.8±452.4) μg·L^-1 at infection.Seventeen patients experienced adverse effects after increased plasma concentrations of CLZ,the largest of which were psychiatric adverse effects.CONCLUSION Upper respiratory tract infection has a certain impact on the increase of clozapine blood concentration,which can lead to adversereactions.Therefore,the monitoring of clozapine blood concentration during hospital infection is very important.We should pay attention to the dose adjustment to reduce the risk of adversereactions.