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目的 分析影响拉莫三嗪 (LTG)稳态血药浓度的相关因素 ,探讨LTG血药浓度监测对癫治疗的重要性。方法 应用LTG [(2 1± 0 9)mg/kg]治疗 3～ 14岁的癫患儿 44例 ,测定其稳态血药浓度。应用逐步回归法分析影响LTG血药浓度的各类因素 ,并推算其有效治疗浓度。结果 LTG血药浓度与剂量、体重、丙戊酸 (VPA)的影响呈正相关 (r分别为 1 82 6、0 0 84、2 774,P均 <0 0 5 ) ,与年龄、卡马西平 (CBZ)的影响呈负相关 (r分别为 - 0 2 86、- 2 382 ,P均 <0 0 5 ) ;性别与其则不存在显著的相关关系 (P >0 0 5 )。三组联合治疗组的血药浓度中位数 (M)分别为 0 75 μg/ml(LTG+CBZ)、2 6 9μg/ml(LTG +VPA +CBZ)和 3 42 μg/ml(LTG +VPA) ,经H检验 ,各治疗组间差异有非常显著性 (H =2 3 94,P <0 0 1)。 2 1例 (5 1 2 % )治疗 3个月后发作次数减少 5 0 %以上或完全控制发作 ,共测定LTG血药浓度 2 7次 ,有效治疗浓度为 3 0 9～ 5 90 μg/ml,明显高于推荐范围的低限 (1μg/ml)。结论 LTG稳态血药浓度可受年龄、体重、给药剂量、联合应用VPA或CBZ等因素的影响 ,故临床应用LTG治疗小儿癫 ,特别在多药联合治疗时 ,仅从给药剂量很难推测其血药浓度 ,有必要开展LTG血药浓度监测 ,以使治疗方案更具个体化
Objective To analyze the influencing factors of steady-state plasma concentration of lamotrigine (LTG), and to explore the importance of LTG monitoring for the treatment of epilepsy. Methods Forty-four children with epilepsy aged 3-14 years old were treated with LTG [(2 1 ± 0 9) mg / kg], and their steady-state plasma concentrations were measured. Stepwise regression analysis of various factors affecting LTG plasma concentration, and calculate the effective treatment concentration. Results The plasma concentration of LTG was positively correlated with the dose, body weight and VPA (r = 1 82 6,0 0 84,2 774 respectively, P <0.05), but not with age, carbamazepine CBZ) were negatively correlated (r = -0.286, -2382, respectively, P <0.05). There was no significant correlation between sex and gender (P> 0.05). The mean plasma concentrations (M) of the three combinations were 0 75 μg / ml (LTG + CBZ), 269 μg / ml (LTG + VPA + CBZ) and 3 42 μg / ml ), H-test, the treatment group differences were significant (H = 2394, P <0.01). The number of seizures was reduced by 50% or more after 2 months (5 1 2%) treatment for 3 months or totally controlled seizures were detected. The total serum concentration of LTG was measured 27 times and the effective therapeutic concentration was 300-990 μg / ml. Significantly above the lower limit of the recommended range (1 μg / ml). Conclusion LTG steady-state plasma concentration can be affected by factors such as age, body weight, administration dose, combination of VPA or CBZ and other factors, so the clinical application of LTG treatment of children with epilepsy, especially in the multi-drug combination therapy, It is difficult to speculate on its plasma concentration, it is necessary to carry out LTG plasma concentration monitoring to make the treatment more individualized