癫痫伴感染患者体内拉莫三嗪与利福平相互作用分析  

Analysis of the lamotrigine-rifampin interaction in epileptic patients with bacterial infection

作　　者：黄文灿[1] 尚德为[1] 朱永坚[1] 张岳峰[1] 温预关[1] 

机构地区：[1]广州医科大学附属脑科医院广州市惠爱医院,广东广州510370

出　　处：《中国医院药学杂志》2017年第15期1494-1497,共4页Chinese Journal of Hospital Pharmacy

基　　金：国家自然科学基金(编号:81403016);广州市医药卫生科技项目(编号:20141A011041);广东省自然科学基金(编号:2015A030313808);广州市重点学科建设院内项目(编号:GBH2014-ZD07)

摘　　要：目的:探究癫痫伴有细菌感染患者进行抗菌治疗时,拉莫三嗪(LTG)与利福平(RFP)在其体内相互作用对LTG血药浓度以及癫痫症状的影响。方法:通过神经科门诊收集16例伴有混合菌感染的癫痫患者,回顾性分析在LTG抗癫痫治疗方案中添加RFP进行抗菌治疗的临床资料,采用LC-MS/MS法监测拉莫三嗪血清浓度,通过自身前后对照以及多疗程间对比的方法观察在为期约2个月的RFP治疗前、治疗中以及停止治疗后LTG标准化血药浓度(CDRLTG)、癫痫症状以及发作次数变化。结果:16例患者的CDRLTG在RFP抗菌治疗第3天有明显的下降。相比于RFP治疗前,6例患者的CDRLTG在治疗第6天下降(44.23±15.78)%,9例患者在第14天下降(66.19±15.73)%,两者有显著统计学差异(P=0.020)。1例患者连续服用RFP42 d后,CDRLTG可由2.65μg·mL^(-1)·kg·mg^(-1)下降至0.38μg·mL^(-1)·kg·mg^(-1)。单一疗程中,多例患者在RFP治疗3~5 d时出现癫痫发作,7 d后却未见症状加重或发作频率升高;多疗程相互比较,患者发作症状较前一疗程减轻,次数减少。结论:RFP可重复显著地降低癫痫患者体内LTG浓度,此作用随着合用时间延长而显著加强。长期抗菌治疗有助于改善癫痫患者症状以及降低发作次数。OBJECTIVE To explore the impacts of lamotrigine（LTG）-rifampin（RFP）interaction on LTG serum concentrations and symptoms of epilepsy,when epileptic patients with bacterial infections received antibacterial therapy.METHODSThe clinical data of sixteen epileptic patients with mixed microbial infection treated with LGT and RFP were analyzed retrospectively.The standardized concentration of LTG（CDRLTG）was monitored by LC-MS/MS and analyzed before,during and after the combined use of LTG and RFP.The differences in seizure frequency and epileptic symptoms were also observed.RESULTS The CDRLTGof patients 3 days after RFP combined therapy was significantly and persistently declined.After combined therapy,CDRLTG was reduced by（44.23±15.78）%after 6 days and by（66.19±15.73）%after 14 days（P〈0.05）.In one patient continuously receiving RFP for 42 days,CDRLTGvalue was declined greatly from2.65μg·mL-1·kg·mg-1 to 0.38μg·mL-1·kg·mg-1.Most patients suffered seizure during combined therapy for 3-5 days,but symptoms or frequency did not further increase≥7 d.Symptoms and frequencies in patients were less than those in the previous course of treatment.CONCLUSIONRFP significantly and repeatedly reduces the concentration of LTG in epileptic patients,which is more obvious as the combined therapy prolongs.Antimicrobial treatment may have auxiliary effects for epileptic patients with microbial infection.

关 键 词：拉莫三嗪 利福平 相互作用 联合用药 

分 类 号：R969.2[医药卫生—药理学]