梁灵君;梁国朝;赵雪茹;高永双;
LIANG Lingjun;LIANG Guochao;ZHAO Xueru;GAO Yongshuang;Zhongshan Third People's Hospital;

• 1:中山市第三人民医院

摘要(Abstract)：

目的 建立某院抗精神病药物治疗药物监测（therapeutic drug monitoring,TDM）平台，以TDM为指导，制定和调整个体化用药方案，促进抗精神病药用药安全、有效、经济。方法 采用高效液相色谱串联质谱（HPLC-MS/MS）分析技术，构建常用抗精神病药物治疗药物监测平台；采集血液样本，采用药物监测平台的分析条件，获得药物血药浓度，对结果进行分析和解读，实施个体化用药。结果 本抗精神病药血药浓度监测平台自建立起，收到院内血药浓度监测样本共3 601例，监测前3位的药物分别为奥氮平1 283例（41.91%），利培酮930例（30.38%），阿立哌唑373例（12.19%）。检测的血液样本中，不在有效范围的共601例（19.63%），其中60%患者经剂量调整后再次复查，血药浓度调整至有效范围。结论 该院抗精神病药治疗药物监测平台的建立能为患者提供个体化治疗，提高疗效，为安全用药提供保障，具有较高的临床应用价值。
OBJECTIVE To establish the therapeutic drug monitoring(TDM) platform of a hospital to formulate and adjust individualized drug regimen under the guidance of TDM in psychiatry department,so as to promote the safety,effectiveness and economy of drug use in psychiatry department.METHODS High performance liquid chromatography-tandem mass spectrometry(HPLC-MS/MS) was used to construct a monitoring platform for commonly used antipsychotics.Blood samples were collected,and the analysis conditions of the drug monitoring platform were adopted to obtain the blood concentration of drugs,and the results were analyzed and interpreted to implement individualized medication.RESULTS Since the establishment of this antipsychotic drug blood concentration monitoring platform,a total of 3 601 cases of blood concentration monitoring in the hospital had been received,including 1 283 cases of olanzapine,accounting for 41.91%,930 cases of risperidone,accounting for 30.38%,and 373 cases of aripiprazole,accounting for 12.19%.Among the blood samples tested,601 cases were not in the effective range,accounting for 19.63%,of which 60% of the patients were re-examined after dose adjustment,and the blood drug concentration was adjusted to the effective range.CONCLUSION The establishment of drug monitoring platform for antipsychotic drug treatment in the hospital can provide individualized treatment for patients,improve curative effect and provide guarantee for safe drug use,which has high clinical application value.

关键词(KeyWords)： 高效液相色谱串联质谱;抗精神病药;治疗药物监测平台
HPLC-MS/MS;antipsyehotic drugs;therapeutic drug monitoring platform

Abstract:

Keywords:

基金项目(Foundation): 中山市社会公益科技研究项目（2019B1081）

作者(Authors): 梁灵君;梁国朝;赵雪茹;高永双;
LIANG Lingjun;LIANG Guochao;ZHAO Xueru;GAO Yongshuang;Zhongshan Third People's Hospital;

参考文献(References)：

• [1]Stephen M S.Stahl精神药理学精要:神经科学基础与临床应用(第3版)[M].司天梅,黄继忠,于欣,译.北京:北京大学医学出版社,2011.
• [2]Ostad Haji E.Hiemke C,Pfuhlmann B.Therapeutic drug monitoring for antidepressant drug treatment[J].Curr Pharm Des,2012,18(36):5818-5827.
• [3]Hiemke C,Baumann P,Bergemann N,et al.AGNP consensus guidelines for therapeutic drug monitoring in psychiatry:Update2011[J].Pharmacopsychiatiy,2011.44(6):195-235.
• [4]方芳,方海红,宋明芬,等.细胞色素P450酶1A2、2D6与多巴胺D2受体基因多态性对奥氮平治疗精神分裂症PANSS减分率的影响[J].中国现代应用药学,2020,37(13):1621-1626.
• [5]Sj?qvist F,Eliasson E.The convergence of conventional therapeutic drug monitoring and pharmacogenctic testing in personalized medicine:Focus on antidepressants[J].Clin Pharmacol Ther,2007,81(6):899-902.
• [6]Mulder H,Herder A,Wilmink F W,et al.The impact of Cytochrome P450-2D6 genotype on the use and interpretation of therapeutic drug monitoring in long-stay patients treated with antidepressant and antipsychotic drugs in daily psychiatric practice[J].Pharmacoepidemiol Drug Saf,2006,15(2):107-114.
• [7]Albers L J,Ozdemir V.Pharmacogenomic-guided rational therapeutic drug monitoring:Conceptual framework and application platforms for atypical antipsychotics[J].Curr Med Chem,2004,11(3):297-312.
• [8]黄善情,肖桃,谢焕山,等.基于治疗药物监测选择性5-羟色胺再摄取抑制剂超警戒浓度原因分析[J].广东药科大学学报,2020,36(6):854-857.
• [9]Andersson M L,Bj?rkhem-Bergman L,Lindh J D.Possible drug-drug interaction between quetiapine and lamotrigine:Evidence from a Swedish TDM database[J].Br J Clin Pharmacol,2011,72(1):153-156.
• [10]胡晋卿,卢浩扬,倪晓佳,等.帕罗西汀的治疗药物监测结果及影响因素研究[J].今日药学,2019,29(8):555-558.
• [11]Vogel F,Gansmiiller R,Leiblein T,et al.The use of ziprasidone in clinical practice:Analysis of pharmacokinetic and pharmacodynamic aspects from data of a drug monitoring survey[J].Eur Psychiatry,2009,24(3):143-148.
• [12]倪晓佳,王占璋,卢浩扬,等.HPLC-MS/MS法同时测定人血清中利培酮与帕利哌酮及奥氮平和喹硫平的浓度[J].中国临床药理学杂志,2018,34(1):53-56.