目的 分析影响拉莫三嗪(lamotrigine，LTG)血药浓度的因素，探讨临床药师在患者使用LTG治疗过程中进行药物治疗管理的效果，更好地促进LTG安全合理使用。方法 采用回顾性研究方法，收集2017年8月—2024年5月郑州市第二人民医院LTG血药浓度监测数据，共196例次，采用单因素和多元线性回归方法分析患者性别、年龄、体质量、LTG日剂量、肝肾功能、合并用药等对LTG血药浓度的影响，探讨影响血药浓度的因素。根据LTG不良反应发生情况，初步探讨不良反应与血药浓度之间的相关性。结果 单因素分析显示，性别、日剂量、肌酐清除率(creatinine clearance rate，Ccr)、联合用药对LTG血药浓度的影响差异均有统计学意义(P＜0。05)。多因素线性回归分析显示，性别(95％CI:-2。647～-0。215，P＜0。05)、LTG日剂量(95％CI:1。860～3。476，P＜0。001)、Ccr(95％CI:0。366～3。188，P＜0。05)、LTG 联合丙戊酸(95％CI:1。958～4。759，P＜0。001)、LTG联合奥卡西平或卡马西平(95％CI:-5。195～-0。268，P＜0。05)是LTG血药浓度的独立影响因素。发生不良反应(adverse drug reaction，ADR)时患者LTG样本的血药浓度[8。50(4。50，9。80)μg/mL]高于未发生ADR时[4。50(2。80，7。40)µg/mL]，但差异无统计学意义(Z=-1。445，P=0。148)。结论 LTG血药浓度受患者性别、LTG日剂量、Ccr、联合使用丙戊酸、奥卡西平或卡马西平的影响。对于使用LTG治疗的患者，临床药师应积极开展个体化药学服务，提高药物治疗的安全性和有效性。
Analysis of risk factors and medication guidance for lamotrigine blood concentration based on therapeutic drug monitoring
Objective To analyze the factors affecting lamotrigine(LTG)blood concentration and to explore the effects of clinical pharmacists in the management of drug therapy during the treatment of patients with LTG,so as to promote the rational application of LTG.Methods A retrospective analysis method was used to collect monitoring data of LTG blood concentration in the Zhengzhou Second Hospital from August 2017 to May 2024,with a total of 196 cases.Univariate and multiple linear regression methods were used to analyze the effects of patient gender,age,body mass,daily LTG dose,liver and kidney function,and concomitant medication on LTG blood concentration,and to explore the factors af-fecting blood drug concentration.Preliminary exploration of the correlation between adverse reactions and blood drug concentration based on the occurrence of LTG adverse reactions.Results The results of univariate analysis showed that there were statistically significant differences in the effects of gender,daily dose,creatinine clearance rate(Ccr),and combination therapy on LTG blood drug concentration.The results of multivariate linear regression analysis showed that gender(95％CI:-2.647 to-0.215,P＜0.05),LTG daily dose(95％CI:1.860 to 3.476,P＜0.001),Ccr(95％CI:0.366 to 3.188,P＜0.05),LTG combined with valproic acid(95％CI:1.958 to 4.759,P＜0.001),LTG combined with oxcarbazepine or carbamazepine(95％CI:-5.195 to 0.268,P＜0.05)were independent influencing factors of LTG blood drug concentration.When adverse drug reaction(ADR)occurred,the blood drug concentration of LTG[8.50(4.50,9.80)μg/mL]was higher than that without adverse reactions[4.50(2.80,7.40)μg/mL],but the difference was not statistically significant(Z=-1.445,P=0.148).Conclusion The blood concentration of LTG is influenced by patient gender,daily dose of LTG,Ccr,combined use of valproic acid,oxcarbazepine,or carbamazepine.For pa-tients treated with LTG,clinical pharmacists should actively provide personalized pharmaceutical services to improve the safety and effectiveness of drug treatment.
LamotrigineTherapeutic drug monitoringClinical pharmacistIndividualized medicationRational drug useInfluencing factor
NETL
NSTL
万方数据
