56℃加热30 min灭活血液标本对选择性5-羟色胺再摄取抑制剂治疗药物监测的影响  

Effect of blood sample inactivation at 56℃30 min on therapeutic drug monitoring of selective serotonin reuptake inhibitors

作　　者：卢浩扬[1] 倪晓佳[1] 王占璋[1] 方子妍[1] 陈宏镇 肖桃 黄善情 谢焕山 尚德为[1] 温预关[1] LU Hao-yang;NI Xiao-jia;WANG Zhan-zhang;FANG Zi-yan;CHEN Hong-zhen;XIAO Tao;HUANG Shan-qing;XIE Huan-shang;SHANG De-wei;WEN Yu-guan(The Affiliated Brain Hospital of Guangzhou Medical University,Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders,Guangdong Guangzhou 510370,China)

机构地区：[1]广州医科大学附属脑科医院、广东省精神疾病转化医学工程技术研究中心,广东广州510370

出　　处：《中国医院药学杂志》2020年第22期2303-2307,共5页Chinese Journal of Hospital Pharmacy

基　　金：国家自然科学基金青年项目(编号:81901328);广州市卫生计生科技项目(编号:20181A00039,20191A011043);广州市科技计划项目创新平台建设计划(编号:201805010009);广州市医学重点学科(2017-2019);广东省省级科技计划项目(编号:2019B0303160001);广东省自然科学基金(编号:2018A030313821);广州市中医药和中西医结合科技项目(编号:20192A010012);2018年广东省卫生计生适宜技术推广项目(粤卫办函[2018]326号-18);广州市荔湾区科技计划项目(编号:201804017)。

摘　　要：目的:评估新型冠状病毒肺炎疫情期间56℃加热30 min灭活血液标本对5-羟色胺再摄取抑制剂治疗药物监测的影响。方法:血清样品用乙腈蛋白沉淀法前处理,用液相色谱串联质谱法测定艾司西酞普兰、氟伏沙明、氟西汀、去甲氟西汀、帕罗西汀和舍曲林血清药物浓度,考察血液标本灭活前后基质效应、血清质控样品灭活后药物稳定性和临床血液标本灭活后对血清药物浓度的影响。结果:6个化合物灭活前后内标归一化基质效应无明显差别,艾司西酞普兰、氟伏沙明、氟西汀、去甲氟西汀和帕罗西汀在该灭活条件下可保持稳定,血液标本灭活后浓度无明显改变,舍曲林灭活后出现降解,而血液标本由于加热后溶血导致细胞内舍曲林扩散至血清中,其灭活后血清浓度反而增加。结论:艾司西酞普兰、氟伏沙明、氟西汀、去甲氟西汀和帕罗西汀的血液标本可用56℃加热30 min灭活处理,而舍曲林在该灭活条件下检测结果不准确。OBJECTIVE To evaluate the effect of blood sample inactivation at 56℃for 30 min on therapeutic drug monitoring of selective serotonin reuptake inhibitors(SSRIs).METHODS Serum samples were pretreated with acetonitrile protein precipitation method,and the serum drug concentrations of escitalopram,fluvoxamine,fluoxetine,norfluoxetine,paroxetine and sertraline were determined by liquid chromatography tandem mass spectrometry.The matrix effect before and after inactivation of blood samples,drug stability after inactivation of serum quality control samples and the effect of inactivation of clinical blood samples on serum drug concentration were investigated.RESULTS There was no significant difference in the normalized matrix effect of internal standard before and after inactivation of the six compounds.Escitalopram,fluvoxamine,fluoxetine,norfluoxetine and paroxetine could remain stable under this inactivation condition.The concentration of blood samples did not change significantly after inactivation,and degradation occurred after inactivation of sertraline.However,the serum concentration of blood samples increased after inactivation due to hemolysis after heating,resulting in the diffusion of sertraline into the serum.CONCLUSION Blood samples of escitalopram,fluovoxamine,fluoxetine,norfluoxetine and paroxetine could be inactivated at 56℃for 30 min without affecting the quantification,while the detection results of sertraline are inaccurate under this inactivated condition.

关 键 词：选择性5-羟色胺再摄取抑制剂 治疗药物监测 新型冠状病毒肺炎 加热灭活 

分 类 号：R96[医药卫生—药理学]