精神障碍患者合并用药对氯氮平血药浓度的影响研究  

Study on the effect of combined medication on the plasma concentration of clozapine in patients with mental disorders

作　　者：骆晓宏 于成盼 马书玉 LUO Xiaohong;YU Chengpan;MA Shuyu(Department of Clinical Laboratory,the Fourth People’s Hospital of Liaocheng City,Shandong,Liaocheng 252000,China)

机构地区：[1]山东省聊城市第四人民医院检验科,山东聊城252000

出　　处：《中国医药科学》2022年第13期159-162,共4页China Medicine And Pharmacy

摘　　要：目的 考察合并用药对精神障碍患者氯氮平血药浓度的影响,为临床合理用药提供参考。方法 选取聊城市第四人民医院精神科2019年1月至2021年5月收治的需用氯氮平控制症状的100例精神障碍患者,根据其临床症状分别在氯氮平治疗的基础上合用普萘洛尔、丙戊酸钠、利培酮、碳酸锂和奥氮平5种药物治疗。依据合并用药种类将研究数据分为五组,每组各观察20例患者。分别于合并用药前、合并用药1周后,采用高效液相色谱法(HPLC)测定并比较精神障碍患者体内氯氮平、去甲氯氮平的血药浓度,分析合并用药对氯氮平血药浓度的影响。结果 普萘洛尔、丙戊酸钠、碳酸锂合并用药1周后与合并用药前比较,氯氮平、去甲氯氮平的血药浓度差异有统计学意义(P <0.05);利培酮、奥氮平合并用药1周后与合并用药前比较,氯氮平、去甲氯氮平的血药浓度差异无统计学意义(P> 0.05)。结论 在精神科内部分常用的药物对氯氮平的血药浓度存在不同程度的影响,临床合并用药时应定期监测氯氮平的血药浓度,及时调整患者氯氮平的服用剂量,使其在有效浓度范围内,避免不良反应的发生,促进其安全、合理用药。Objective To examine the effect of combined medication on the plasma concentration of clozapine in patients with mental disorders, and to provide a reference for the rational clinical medication. Methods A total of 100 patients with mental disorders who required clozapine for symptom control admitted to the Department of Psychiatry of the Fourth People’s Hospital of Liaocheng City from January 2019 to May 2021were included, and five drugs, propranolol, sodium valproate, risperidone, lithium carbonate and olanzapine were combined with clozapine for treatment according to their clinical symptoms. Study data was divided into 5 groups according to the type of drug combination, with the data of 20 patients in each group. The plasma concentrations of clozapine and desmethylclozapine in patients with mental disorders were measured by highperformance liquid chromatography(HPLC) before and after 1 week of combined medication, respectively, the measured values were compared, and the effect of combined medication on the plasma concentration of clozapine was analyzed. Results There were statistically significant differences in plasma concentrations of clozapine and desmethylclozapine before propranolol, sodium valproate and lithium carbonate were combined and after 1 week of combined medication(P < 0.05), while there were no statistically significant differences in plasma concentrations of clozapine and desmethylclozapine before risperidone and olanzapine were combined and after 1 week of combined medication(P > 0.05). Conclusion Some drugs commonly used in the department of psychiatry have different degrees of effect on the plasma concentration of clozapine, so the plasma concentration of clozapine should be monitored regularly when combined medication is implemented in clinical practice, and the dose of clozapine should be adjusted in time to keep it within the effective concentration range to avoid the occurrence of adverse reactions and promote its safe and rational use.

关 键 词：氯氮平 去甲氯氮平 合并用药 血药浓度 

分 类 号：R749.3[医药卫生—神经病学与精神病学]