背景:氯氮平是治疗耐药性精神分裂症的最有效药物,氯氮平治疗精神疾病的剂量和浓度在不同人群中差异很大,受多种因素影响。
方法:检测3734例精神病患者的血清氯氮平浓度,以及每日剂量的数据,性别,收集年龄和其他医疗记录进行统计分析.
结果:平均日剂量,氯氮平的平均血清浓度和平均C/D(浓度/剂量)比率为191.02±113.47mg/天,326.15±235.66ng/mL和1.94±1.25ng/mL/mg/天,分别。男女之间的日剂量有差异,女性的日剂量较高(p<0.01),较高的血清氯氮平浓度(p<0.01)和较高的C/D比(p<0.01)。日剂量存在显着差异(p<0.001),不同年龄组的血清药物浓度(p<0.001)和C/D比值(p<0.001)。日剂量随着年龄的增长而减少(p为趋势<0.001),C/D比值随年龄增长而增加(p为趋势<0.001)。住院患者和门诊患者的日剂量没有差异,但是住院患者的血清浓度(p<0.001)和C/D比(p<0.001)更高。不同职业的日剂量没有差异,但血清浓度(p<0.001)和C/D比(p<0.001)存在显着差异,和失业患者可能有更高的血清浓度和C/D比。疾病持续时间,合并症,婚姻状况,和精神病类型可能会影响每日剂量和血清浓度。
结论:研究区域中氯氮平的有效日剂量和血清浓度可能低于推荐水平,和女性有较高的血清浓度和较慢的代谢率。随着年龄的增长,每日剂量减少,代谢率减慢。住院状态和患者职业可能影响氯氮平的血清浓度和代谢率。
Clozapine is the most effective drug for treatment-resistant schizophrenia, and the dosage and concentration of clozapine in the treatment of mental illness vary greatly in different populations and are affected by many factors.
The serum clozapine concentration of 3734 psychiatric patients was detected, and data on daily dose, sex, age and other medical records were collected for statistical analysis.
The mean daily dose, mean serum concentration and mean C/D (concentration/dose) ratio of clozapine were 191.02 ± 113.47 mg/day, 326.15 ± 235.66 ng/mL and 1.94 ± 1.25 ng/mL per mg/day, respectively. There was difference in daily dose between sexes, and females had higher daily dose (p <0.01), higher serum clozapine concentrations (p < 0.01) and higher C/D ratios (p < 0.01). There were significant differences in daily dose (p < 0.001), serum drug concentration (p < 0.001) and C/D ratio (p < 0.001) among different age groups. The daily dose decreased with age (p for trend < 0.001), and the C/D ratio increased with age (p for trend < 0.001). Inpatients and outpatients had no difference in daily dose, but inpatients had higher serum concentration (p < 0.001) and C/D ratio (p < 0.001). There was no difference in daily dose among different occupations, but there were significant differences in serum concentration (p < 0.001) and C/D ratio (p < 0.001), and unemployed patients may have higher serum concentration and C/D ratio. Duration of disease, comorbidity, marital status, and psychotic type may influence the daily dose and serum concentration.
The effective daily dose and serum concentration of clozapine in the study area may be lower than recommended levels, and women have higher serum concentrations and slower metabolic rates. With increasing age, the daily dose decreases, and the metabolic rate slows. Inpatient status and occupation of patients may influence the serum concentration and metabolic rate of clozapine.