丙戊酸钠血清浓度接近或超过治疗浓度范围上限患者的肝功能、血常规结果分析  

Analysis of liver function and blood routine of the patients with sodium valproate serum concentration above 90 μg·mL^(-1)

作　　者：曾艳[1] 刘立丽[1] 闫素英[1] 

机构地区：[1]首都医科大学宣武医院药剂科,北京100053

出　　处：《中国药物应用与监测》2013年第2期66-70,共5页Chinese Journal of Drug Application and Monitoring

摘　　要：目的:探讨丙戊酸钠血清浓度接近或超过治疗浓度范围上限患者的肝脏功能及血液系统的状态,为安全应用丙戊酸钠提供参考。方法:收集2011年1月1日–2012年10月30日在首都医科大学宣武医院测定丙戊酸钠血清浓度结果大于90μg·mL-1的癫痫患者的临床资料,包括患者一般情况、丙戊酸钠用法用量、患者的肝功能、血常规指标,并对其进行回顾性分析。结果:共有70名患者的丙戊酸钠血清浓度在90~160μg·mL-1;34.8%(24/69)的患者肝功能指标出现异常,主要表现为碱性磷酸酶、天门冬氨酸氨基转移酶、γ-谷氨酰基转移酶高于正常范围;63.5%(33/52)的患者血常规指标出现异常,主要表现为中性粒细胞比例或计数、血小板计数(PLT)低于正常范围。结论:丙戊酸钠血清浓度为90~160μg·mL-1的患者均未出现严重的不良反应或肝功能、血常规指标的严重异常,丙戊酸钠血清浓度>100μg·mL-1是否应定为危急值还值得商榷,但应严密监测患者肝功能、血常规等指标。Objective： To explore the state of the liver function and hematologic system of the patients whose sodium valproate serum concentrations were approaching or above the upper limit of the therapeutic concentration range （90 μg·mL^-1）, and provide reference for safe use of sodium valproate. Methods： The data of epileptic patients whose concentrations of sodium valproate were above 90 μg·mL^-1 in Xuanwu Hospital of Capital Medical University from Jan. 1, 2011 to Oct. 30, 2012 were analyzed retrospectively in respect of the basic characteristics of patients, dosage and administration of sodium valproate, some important indicators of liver function and blood routine. Results： There were 70 patients in this study, whose valproate serum concentrations were between 90 ~tg. mL-1 and 160 gg. mL-1. Twenty-four patients （34.8%, 24/69） developed abnormal liver functions, and alkaline phosphatase, aspartate aminotransferase or gamma-glutamyltransferase above normal ranges were the main clinical manifestations. And there were 33 patients （63.5%, 33/52） with abnormal blood routine, such as the percent or count of neutrophile granulocyte, count of platelet below normal ranges. Conclusion： Among patients whose concentrations of sodium valproate were between 90 μg·mL^-1 and 160 μg·mL^-1, there was no any serious abnormal indicator of liver function and blood routine or other serious adverse drug reaction. It is worthy of discussing whether the concentrations of sodium valproate above 100 μg·mL^-1 should be defined as critical clinical value, although these patients＇ liver function and status of hematologic system should be monitored closely.

关 键 词：丙戊酸钠 中毒 血清浓度 肝功能 血常规 

分 类 号：R96[医药卫生—药理学]