门诊患者艾司西酞普兰血药浓度及剂量校正浓度的影响因素分析  

Influencing factors of escitalopram serum concentration and dose-adjusted serum concentration in outpatients

作　　者：曾环思[1] 彭陈陈 钟易霖 李维柯 刘云 蒋家兵 王裕锋 刘运宇 吴伟翔 钟彩妮[3] ZENG Huansi;PENG Chenchen;ZHONG Yilin;LI Weike;LIU Yun;JIANG Jiabing;WANG Yufeng;LIU Yunyu;WU Weixiang;ZHONG Caini(Biochemistry and Pharmacy Laboratory,Shenzhen Kangning Hospital/Shenzhen Mental Health Center,Guangdong Shenzhen 518020,China;Department of Information,Shenzhen Kangning Hospital/Shenzhen Mental Health Center,Guangdong Shenzhen 518020,China;Department of Pharmacy,Shenzhen Kangning Hospital/Shenzhen Mental Health Center,Guangdong Shenzhen 518020,China)

机构地区：[1]深圳市康宁医院/深圳市精神卫生中心生化与药学实验室,广东深圳518020 [2]深圳市康宁医院/深圳市精神卫生中心信息科,广东深圳518020 [3]深圳市康宁医院/深圳市精神卫生中心药学部,广东深圳518020

出　　处：《广东药科大学学报》2022年第5期12-16,共5页Journal of Guangdong Pharmaceutical University

基　　金：广东省医学科研基金项目(B2021035);广东省基础与应用基础研究基金自然科学基金项目(2020A1515011290);深圳市科技计划项目(JCYJ20190809155403596);广东省高水平临床重点专科(深圳市配套建设经费)资助项目(SZGSP013)。

摘　　要：目的研究门诊患者艾司西酞普兰的血药浓度和剂量校正浓度(dose-adjusted serum concentration,C/D)的影响因素,为治疗药物监测(therapeutic drug monitoring,TDM)的临床应用提供参考。方法纳入2019年1月-2021年12月门诊服用艾司西酞普兰的患者1881例,比较日剂量、性别、年龄、药物生产厂家、肝肾功能和联合用药对艾司西酞普兰血药浓度及C/D的影响。结果门诊患者艾司西酞普兰日剂量为15 mg(10.00,20.00),平均血药浓度为23.60 ng/mL(13.30,40.20),平均C/D为1.65 ng/(mL·mg)·d(0.93,2.56)。女性组的C/D较男性组高(P<0.05),30岁以上患者组的C/D较30岁以下的高(P<0.05);联合细胞色素P450(cytochrome P450,CYP450)抑制剂和联合CYP450底物的C/D明显大于无联合组,联合抑制剂组的C/D是无联合组的1.88倍(P<0.05)。多元线性回归分析结果显示,日剂量、性别、年龄、联合底物或联合抑制剂对艾司西酞普兰血药浓度的影响具有统计学意义(P<0.05)。结论门诊患者艾司西酞普兰血药浓度影响因素复杂,临床应根据血药浓度调整用药剂量,尽量避免联合使用CYP450酶的抑制剂。Objective To investigate the influencing factors of serum concentration and dose-adjusted serum concentration(C/D)in outpatients with escitalopram,so as to provide reference for the therapeutic drug monitoring(TDM).Methods A retrospective analysis was carried out to analyze the effects of dosage,gender,age,drug manufacturer,liver function,kidney function,and comedication on serum concentration of escitalopram and C/D of 1881 outpatients in Shenzhen Kangning Hospital/Shenzhen Mental Health Center from January 2019 to December 2021.Results The mean dosage of escitalopram for outpatients was 15 mg(10.00,20.00).The mean serum concentration of escitalopram was 23.60 ng/mL(13.30,40.20),and the mean C/D was 1.65 ng/(mL·mg)·d(0.93,2.56).The C/D of the female group were higher than those of the male group,and the C/D of patients over 30 years old were higher than those of patients under 30 years old(P<0.05).The C/D of the combined cytochrome P450(CYP450)inhibitor and the combined CYP450 substrate groups were significantly higher than those of theno comedication group.The C/D of the combined inhibitor group were 1.88 times higher than those of the no combined group(P<0.05).The results of multiple linear regression analysis showed that effects of dosage,gender,age,combined substrate or combined inhibitor on serum concentration of escitalopram were statistically significant(P<0.05).Conclusions The influencing factors of serum concentration of escitalopram in outpatients are complicated.The dosage of escitalopram should be adjusted according to the serum concentration,and the combined CYP450 inhibitors should be avoided.

关 键 词：艾司西酞普兰 治疗药物监测 血药浓度 剂量校正浓度 

分 类 号：R971.4[医药卫生—药品]