抗精神病药物血药浓度及其剂量比的影响因素

doi:10.19803/j.1672-8629.20240744

摘要/Abstract

摘要： 目的分析抗精神病药物血药浓度的影响因素,为药物浓度监测的临床应用提供参考。方法收集本院2023年1月1日至12月31日进行抗精神病药物治疗的门诊患者性别、年龄、给药剂量、血药浓度等基本信息,采用SPSS 26.0统计学软件对数据进行统计分析。结果共收集2 055例患者的血药浓度监测数据,涉及11种抗精神病药物,推荐治疗参考范围的达标率中最高为氟哌啶醇（82.35%）,最低为氯氮平（14.41%）;在多重线性回归分析中,性别、年龄、给药剂量仅能解释部分血药浓度变化。除阿立哌唑、喹硫平,女性患者抗精神病药物浓度剂量比（C/D）高于男性患者,仅利培酮的差异具有统计学意义,即同样的给药剂量,女性患者的稳态谷浓度更大;年龄与抗精神病药物浓度剂量比（C/D）没有明显的关联性,差异无统计学意义。结论抗精神病药物具有较大的个体间差异,且影响血药浓度的因素较复杂,剂量、性别和年龄均可能造成其血药浓度波动,建议临床加强抗精神病药物的血药监测。

关键词: 抗精神病药物, 利培酮, 血药浓度, 剂量比, 合理用药

Abstract: Objective To analyze the effects of gender, age and dosage on serum concentrations of antipsychotics, and to provide a reference for clinical applications of drug concentration monitoring. Methods The clinical data of outpatients who received antidepressant treatment in 2023, such as gender, age, dosage, and serum drug concentrations, was collected before being analyzed statistically using SPSS 26.0 ResultsThe data on serum concentration monitoring was collected from a total of 2 055 patients, involving 11 antipsychotics. The rate of compliance with the recommended range for treatment was the highest with haloperidol (82.35%) and lowest with clozapine (14.41%). According to the multiple linear regression equation, gender, age and dosage could do nothing more than account for some of the changes in serum drug concentrations. Except for aripiprazole and quetiapine, the C/D value of antipsychotic drugs was higher among females than among males, but there was a statistically significant difference in the case of risperidone, that is, the steady-state trough concentration of female patients was higher at the same dosage as males. There was no significant correlation between age and the C/D value of antipsychotic drugs, and the difference was not statistically significant. Conclusion There is considerable difference between individuals using antipsychotics, and there are many factors that affect serum drug concentrations. Dosage, gender, and age may all cause fluctuations in serum drug concentrations that should be monitored more rigorously when antidepressants are used.

Key words: Antipsychotics, Risperidone, Blood Drug Concentration, Dose Ratio, Rational Drug Use

中图分类号:

梅丽平, 白福臣, 于杰, 张春杰, 王亚军, 安丽梅. 抗精神病药物血药浓度及其剂量比的影响因素[J]. 中国药物警戒, 2025, 22(4): 424-428.

MEI Liping, BAI Fuchen, YU Jie, ZHANG Chunjie, WANG Yajun, AN Limei. Determinants of Blood Drug Concentration / Dose Ratio of Antipsychotics[J]. Chinese Journal of Pharmacovigilance, 2025, 22(4): 424-428.

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参考文献

[1] HOWES OD, CUMMINGS C, CHAPMAN GE, et al.Neuroimaging in Schizophrenia: an Overview of Findings and Their Implications for Synaptic Changes[J]. Neuropsychopharmacology, 2023, 48(1): 151-167.
[2] XIE L, LIANG LY, ZHANG BB.Effect of Dyslipidemia Caused by Atypical Antipsychotics on Bone Turnover Markers in Patients with Schizophrenia[J]. Journal of Clinical Psychiatry(临床精神医学杂志), 2022, 32(2): 111-113.
[3] RAFIZADEH R, SOOCH A, BOUSMAN CA, et al.Impact of Patient-Specific Factors on Clozapine Metabolism in Individuals with Treatment-Resistant Schizophrenia or Schizoaffective Disorder[J]. Journal of Psychopharmacology(Oxford, England), 2024, 38(6) : 526-531.
[4] LAPPALAINEN M, HÄRKÄNEN M, KUOSMANEN L, et al. Effectiveness of Providing Information on Antipsychotic Medication to Patients with Psychotic Disorders: an Integrative Review[J]. Issues in Mental Health Nursing, 2023, 44(5): 373-386.
[5] Division of Therapeutic Drug Monitoring, Chinese Pharmacological Society, Chinese Psychiatrist Association; Division of Drug-Induced Diseases, Chinese Pharmacological Society,et al. Expert Consensus on Clinical Application of Psychiatric Therapeutic Drug Monitoring in China (2022edition)[J]. Journal of Neuroscience and Mental Health(神经疾病与精神卫生), 2022, 22(8): 601-608.
[6] LI Y, QU FL, WANG L, et al.Study on the Influencing Factors in Serum Drug Concentration/Dose Ratio of Aripiprazole[J]. China Pharmacist(中国药师), 2022, 25(3): 455-457.
[7] ZHONG LL, CHEN Z, LI YJ, et al.Analysis of Influential Factors on Serum Concentration/Dose Ratio of Aripipra-Zole and Clinical Application[J]. Guangzhou Medical Journal(广州医药), 2022, 53(3): 100-103.
[8] ZHANG M, CHEN HZ, WEN YG, et al.Influencing Factors of Olanzapine Blood Concentration/Dose Ratio and Its Clinical Application of Therapeutic Drug Monitoring[J]. Evaluation and Analysis of Drug-Use in Hospitals of China(中国医院用药评价与分析), 2019, 19(7): 795-796, 800.
[9] WANG YQ, CHANG LY, ZHOU CH, et al.Analysis of Influential Factors for Dose-Corrected Trough Concentration of Amisulpride Based on Therapeutic Drug Monitoring[J]. China Pharmacy(中国药房), 2022, 33(24): 3020-3024.
[10] DING WJ, WANG YN, YANG KF, et al.Monitoring Results and Influencing Factors of Clozapine Plasma Concentration in Patients with Mental Disorders[J]. Journal of Chinese Physician(中国医师杂志), 2023, 25(7): 1056-1060.
[11] CHEN YY, SUN GB, LIN XC, et al.Research on the Influential Factors of Plasma Concentration/Dose Ratio of Clozapine in Schizophrenia Patients[J]. Chinese Journal of Drug Application and Monitoring(中国药物应用与监测), 2021, 18(2): 88-91.
[12] HAO YP, ZHOU CH, YU J, et al.Analysis of Influencing Factors of Serum Concentration for Quetiapine Based on Therapeutic Drug Monitoring[J]. The Chinese Journal of Clinical Pharmacology(中国临床药理学杂志), 2023, 39(12): 1708-1712.
[13] PENG JW, WENG X, HE PH.Analysis of 80 Cases of Adverse Drug Reactions in Elderly Patients with Mental Disorders[J]. Journal of China Prescription Drug(中国处方药), 2024, 22(12): 88-91.
[14] QIN WG, HAN CL, HUANG NL, et al.Efficacy and Safety of Combination Treatment with Clozapine in Treatment-Resistant Schizophrenia[J]. Journal of Clinical Psychiatry(临床精神医学杂志), 2022, 32(3): 231-235.
[15] XU HL, LANG LJ, YANG J, et al.The Relationship between the Adverse Reactions of Antipsychotic Drug Olanzapine and the Blood Drug Concentration[J]. Chinese Journal of Clinical Rational Drug Use(临床合理用药), 2024, 17(7): 172-173, 177.
[16] LÄHTEENVUO M, TIIHONEN J. Antipsychotic Polypharmacy for the Management of Schizophrenia: Evidence and Recommendations[J]. Drugs, 2021, 81(11): 1273-1284.