基于治疗药物监测选择性5-羟色胺再摄取抑制剂超警戒浓度原因分析  

Analysis on the cause of the over alert level of 5-hydroxytryptamine reuptake inhibitor based on therapeutic drug monitoring

作　　者：黄善情 肖桃 谢焕山 陈宏镇 卢浩扬[1] 倪晓佳[1] 王占璋[1] 张明[1] 温预关[1] 尚德为[1] HUANG Shanqing;XIAO Tao;XIE Huanshan;CHEN Hongzhen;LU Haoyang;Ni Xiaojia;WANG Zhanzhang;ZHANG Ming;WEN Yuguan;SHANG Dewei(The Affiliated Brain Hospital Of Guangzhou Medical University,Guangzhou 510370,China;The Center of Chronic Disease Control in Zhuhai / Zhuhai Third Peoples Hospital,Zhuhai 519000,China)

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 [2]珠海市慢性病防治中心/珠海市第三人民医院,广东珠海519000

出　　处：《广东药科大学学报》2020年第6期854-857,共4页Journal of Guangdong Pharmaceutical University

基　　金：国家自然科学基金项目(81403016);广东省卫生计生适宜推广项目(粤卫办函[2018]326号);广东省省级科技计划项目(2019B030316001);广州市科技计划项目(201805010009);广州市医药卫生科技项目(20191A011040);广东省中医药局科研项目(20201272)。

摘　　要：目的通过对长期使用5-羟色胺再摄取抑制剂(Selective serotonin reuptake inhibitors,SSRIs)患者血药浓度监测结果调查分析,为临床合理用药提供建议。方法回顾性分析广州医科大学附属脑科医院2019—2020年5269例SSRIs(氟西汀,氟伏沙明,艾司西酞普兰,舍曲林,帕罗西汀)血药浓度的检测结果,通过比较超警戒浓度的比率,分析SSRIs的用药情况,对超警戒浓度比率过高的药物进行原因分析。结果帕罗西汀和氟伏沙明超警戒浓度比率较高;帕罗西汀超警戒浓度的女性比例更高,试验组给药剂量与剂量校正浓度(C/D)都明显大于对照组(P<0.05),试验组的给药剂量与C/D分别是对照组的1.5倍和3.5倍;氟伏沙明给药剂量与C/D组间差异均具有统计学意义(P<0.05),试验组给药剂量与C/D是对照组的1.2倍与3.6倍。结论临床上使用SSRIs进行抗抑郁治疗时,应重视帕罗西汀和氟伏沙明的个体化用药,并结合临床疗效和治疗药物监测,实施科学药学监护。Objective To investigate and analyze the serum concentration monitoring in patients with long-term use of 5-hydroxytryptamine reuptake inhibitor(SSRIs),so as to provide some suggestions for rational drug use in clinical practice.Methods A retrospective analysis of 5269 concentrations of SSRIs(fluoxetine,fluvoxamine,escitalopram,sertraline,paroxetine)in the Affiliated Brain Hospital of Guangzhou Medical University from 2019 to 2020 was conducted.By comparing the ratio of laboratory alert level,the use of SSRIs and the reasons for excessively alert concentrations were analyzed.Results Paroxetine and fluvoxamine had a high ratio of over-alert concentration.The proportion of women with excessive paroxetine levels was higher.The dose-corrected concentration(C/D)was significantly greater than that of the control group(P<0.05).The dose and C/D of the test group were 1.5 times and 3.5 times that of the control group.There was a statistical difference between the fluvoxamine dose and the C/D group(P<0.05).The dose and C/D of the test group were 1.2 times and 3.6 times that of the control group.Conclusion In the clinical use of SSRIs for antidepressant treatment,individualized medication of paroxetine and fluvoxamine should be paid attention,combined with clinical efficacy and therapeutic drug monitoring,and scientific pharmaceutical monitoring should be implemented.

关 键 词：5-羟色胺再摄取抑制剂 治疗药物监测 警戒浓度 帕罗西汀 氟伏沙明 

分 类 号：R965.3[医药卫生—药理学]