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奥卡西平活性代谢产物测定在儿童局灶性癫[疒间]治疗中的应用 预览

Clinical application of blood concentration monitoring of active metabolite of oxcarbazepine in childhood focal epilepsy
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摘要 目的 探讨奥卡西平活性代谢产物10-单羟基卡马西平(MHD)血药浓度测定在儿童局灶性癫治疗中的应用价值。方法 共110例儿童局灶性癫患者于奥卡西平单药或药物联合治疗3个月后,采用高效液相色谱法测定MHD血药谷浓度。结果 110例患儿奥卡西平平均治疗剂量(25.52±7.28)mg/(kg·d),MHD中位血药谷浓度7.00(4.95,10.50)mg/L,89例(80.91%)〈12 mg/L。Spearman秩相关分析,MHD血药谷浓度与奥卡西平治疗剂量呈正相关(rs=0.337,P=0.000)。奥卡西平治疗剂量仅年长(〉7岁)局灶性癫患儿低于年幼(≤7岁)患儿且差异有统计学意义[(23.13±5.56)mg/(kg·d)对(28.09±8.06)mg/(kg·d);t=3.778,P=0.000],而男性与女性(t=1.067,P=0.288)、药物难治性与非药物难治性(t=1.417,P=0.159)、单药治疗与药物联合治疗(t=1.671,P=0.098)组间差异无统计学意义;MHD血药谷浓度仅药物难治性局灶性癫患儿低于非药物难治性患儿且差异有统计学意义[6.32(3.05,8.58)mg/L对8.30(5.75,10.85)mg/L;Z=2.380,P=0.017],而男性与女性(Z=0.604,P=0.546)、年长与年幼(Z=0.179,P=0.858)、单药治疗与药物联合治疗(Z=1.583,P=0.113)组间差异无统计学意义。结论 MHD血药谷浓度与奥卡西平治疗剂量呈正相关关系;为达到相同的MHD血药浓度,年幼局灶性癫患儿应服用更大剂量的奥卡西平;奥卡西平治疗儿童药物难治性局灶性癫时,应根据MHD血药浓度及时调整药物剂量。 Objective To investigate the value of blood concentration monitoring of 10- monohydroxy carbamazepine (MHD), the active metabolite of oxearbazepine (OXC), in the treatment of childhood focal epilepsy. Methods A total of 110 children with focal epilepsy took OXC for 3 months and then the MHD concentrations were determined by high pressure liquid chromatography (HPLC). Results The average dose of OXC in 110 children was (25.52 ± 7.28) mg/(kg, d) and the valley point concentration of MHD was 7.00 (4.95, 10.50) mg/L, and 89 cases (80.91%) 〈 12 mg/L. A linear relationship between MHD valley point concentration and OXC dose (r, = 0.337, P = 0.000) was shown by Spearman rank correlation analysis. The dosage of OXC for older ( 〉 7 years) children was significantly lower than that of younger (≤ 7 years) children [(23.13 ± 5.56) mg/(kg· d) vs. (28.09 ± 8.06) mg/(kg·d); t = 3.778, P = 0.000], while there was no significant difference between the concentration of children with different sexes (t = 1.067, P = 0.288), between children with and without drug resistant epilepsy (DRE; t = 1.417, P = 0.159) and between monotherapy and combination drug therapy (t = 1.671, P = 0.098). The MHD valley point concentration in DRE group was lower than that of non-DRE group [6.32 (3.05, 8.58) mg/L vs. 8.30 (5.75, 10.85) mg/L; Z = 2.380, P = 0.017], while there was no significant difference between the concentration of children with different sexes (Z = 0.604, P = 0.546), between older and younger children (Z = 0.179, P = 0.858) and between monotherapy and combination drug therapy (Z = 1.583, P = 0.113). Conclusions There is a linear relationship between MHD steady state valley point concentration and the dose of OXC. To achieve the same MHD level, the younger children need to take a larger dose of OXC. When OXC is used to treat drug resistant focal epilepsy in children, the dosage should be adjusted according to the monitoring of b
作者 张培元 李惠芬 刘晓军 于晓莉 张玉琴 ZHANG Pei-yuan1, LI Hui-fen2, LIU Xiao-jun1, YU Xiao-li1, ZHANG Yu-qin1(1Department of Neurology, Tianjin Children's Hospital, Tianjin 300134, China ;2Tianjin Institute of Pediatrics, Tianjin 300074, China)
出处 《中国现代神经疾病杂志》 CAS 北大核心 2018年第6期438-442,共5页 Chinese Journal of Contemporary Neurology and Neurosurgery
基金 天津市卫生局科技基金资助项目(项目编号:2011KZ35)
关键词 儿童 卡马西平 血药浓度 色谱法 高压液相 Epilepsy Child Carbamazepine Plasma concentration Chromatography high pressure liquid
作者简介 通讯作者:张玉琴(Email:zhangyuqin0809@sina.com)
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