艾司西酞普兰血药浓度/剂量比的影响因素研究  

Influencing Factors of Serum Concentration/Dose Ratio of Escitalopram

作　　者：钟璐莲 陈政 郭媛媛[2] 刘云[2] 盛小茜 贾晓健 ZHONG Lulian;CHEN Zheng;GUO Yuanyuan;LIU Yun;SHENG Xiaoxi;JIA Xiaojian(Dept.of Pharmacy,Shenzhen Mental Health Center/Shenzhen Kangning Hospital,Guangdong Shenzhen 518118,China;Research Institute of Pharmacy,Shenzhen Mental Health Center/Shenzhen Kangning Hospital,Guangdong Shenzhen 518118,China)

机构地区：[1]深圳市精神卫生中心/深圳市康宁医院药学部,广东深圳518118 [2]深圳市精神卫生中心/深圳市康宁医院研究所,广东深圳518118

出　　处：《中国医院用药评价与分析》2022年第6期668-671,共4页Evaluation and Analysis of Drug-use in Hospitals of China

基　　金：广东省基础与应用基础研究基金项目(No.2021A1515012141)。

摘　　要：目的:探讨住院患者服用艾司西酞普兰后血药浓度/剂量比(C/D)的影响因素,为临床合理用药提供依据。方法:收集2019年10月至2021年11月该院服用艾司西酞普兰的住院患者血药浓度监测数据样本275份,使用SPSS 25.0统计学软件对数据进行回顾性分析。结果:经多元线性回归分析,本研究仅发现代谢酶CYP2C19代谢类型、日剂量2个因素可解释艾司西酞普兰血药浓度的显著变化。服用艾司西酞普兰的患者,女性组C/D值显著高于男性组,差异有统计学意义(P=0.021<0.05);与艾司西酞普兰联合应用的药物方面,联合利培酮组与联合氯氮平组(P=0.035<0.05)、联合普萘洛尔组与联合奥美拉唑组(P=0.030<0.05)、联合普萘洛尔组与联合氯氮平组(P=0.021<0.05)的C/D值比较,差异均有统计学意义;代谢酶CYP2C19慢代谢型、快代谢型和中间代谢型患者组间C/D值的差异均有统计学意义(P<0.05);其他因素如年龄、厂家、其他联合用药和CYP2D6与艾司西酞普兰C/D值无相关性对艾司西酞普兰C/D值的影响,差异均无统计学意义(P>0.05)。结论:艾司西酞普兰的C/D值与性别、部分联合用药和CYP2C19基因分型有关,临床可加强治疗药物监测,结合血药浓度、基因分型、临床诊疗效果及药物经济学优化给药方案。OBJECTIVE:To investigate the influencing factors of serum concentration to dose ratio(C/D)of escitalopram in inpatients,so as to provide basis for clinical rational drug use.METHODS:Monitoring data of serum concentration from^(2)75 inpatients treated with escitalopram from Oct.2019 to Nov.2021 were collected and retrospectively analyzed by using SPSS 25.0 statistical software.RESULTS:According to multiple linear regression analysis,only metabolism type of metabolic enzyme CYP2C19 and daily dose could explain the significant changes in the serum concentration of escitalopram.The C/D of escitalopram in inpatients was significantly higher in the female group than in the male group(P=0.021<0.05).In terms of drug combination,significant differences in the C/D were detected between the groups of escitalopram combined with risperidone and combined with clozapine(P=0.035<0.05),escitalopram combined with propranolol and combined with omeprazole(P=0.030<0.05),and escitalopram combined with propranolol and combined with clozapine(P=0.021<0.05).Moreover,there were statistically significant differences in C/D values among the slow,fast and intermediate metabolism types of metabolic enzyme CYP2C19(P<0.05).Other factors such as age,manufacturer,other drug combination and metabolic enzyme CYP2D6,had no relation with statistically significant difference on the C/D value of escitalopram(P>0.05).CONCLUSIONS:The C/D value of escitalopram is related to gender,partial drug combination and CYP2C19 genotyping,and clinical monitoring of therapeutic drugs can be enhanced to optimize dosing regimens in combination with blood levels,genotyping,clinical outcomes and pharmacoeconomics.

关 键 词：艾司西酞普兰 血药浓度 CYP2C19 合理用药 

分 类 号：R971.4[医药卫生—药品]