检索结果-南通市图书馆

World Journal of Gastroenterology 2009年第19期15卷 2305-2308页

作者： Paolo conca Giovanni Tarantino Department of Clinical and Experimental Medicine Federico University Medical School of Naples

Hepatitis C virus(HCV) has been recognized to be both a hepato-and lymphotropic *** lymphotropism represents an essential lap in the pathogenesis of virusrelated autoimmune and lymphoproliferative disorders,ranging from clonal expansion of B-cells with organ-and non-organ-specific autoantibody production up to overt non-Hodgkin's lymphoma along a continuous step-by-step model of B-cell lymphomagenesis,where the intermediated mixed cryoglobulinemia could be considered as a stage of suppressible antigen-driven *** infection of lymphoid cells could set up privileged reservoirs able to interfere with the host viral clearance eff iciency and may be implicated in viral recurrence after apparently successful antiviral *** HCV long-lasting extrahepatic replicative state generates an abnormal systemic immunological response,easily detectable by searching simple laboratory and clinical parameters,mainly represented by vasculitis-like skin features and *** presence or absence of this hypersensitivity pattern seems to correlate with the antiviral response and could be identif ied as a novel immunological *** research is required to fully verify the real impact on therapeutic choice/regimen.

关键词：丙型肝炎病毒感染抗病毒治疗免疫表型非霍奇金淋巴瘤自然史细胞增生性疾病自身免疫性器官特异性

神经精神药理学治疗药物监测共识指南:2017版

在线全文

维普期刊数据库

学校读者我要写书评

暂无评论

实用药物与临床 2022年第2期25卷 97-118页

作者： C.Hiemke N.Bergemann H.W.Clement a.conca J.Deckert K.Domschke G.Eckermann K.Egberts M.Gerlach C.Greiner G.Gründer E.Haen U.Havemann-Reinecke G.Hefner R.Helmer G.Janssen E.Jaquenoud G.Laux T.Messer R.M ssner M.JMüller M.Paulzen B.Pfuhlmann P.Riederer A.Saria B.Schoppek G.Schoretsanitis M.Schwarz M.Silva Gracia B.Stegmann W.Steimer J.C.Stingl M.Uhr S.Ulrich S.Unterecker R.Waschgler G.Zernig G.Zurek P.Baumann 李文标(译) 果伟(译) 贺静(译) 鲍爽(译) 路钊(译) 牛梦溪(译) 阮灿军(译) 臧彦楠(译) 王勇(译) 张玲(译) 刘辰庚(译) 李洁(译) 汤宜朗(译) 王传跃(译) 王刚(译) Department of Psychiatry and Psychotherapy University Medical Center of MainzMainzGermany Institute of Clinical Chemistry and Laboratory Medicine University Medical Center of MainzMainzGermany Kitzberg Hospitals Center for Psychosomatic Medicine and PsychotherapyBad MergentheimGermany Department of Child and Adolescent Psychiatry University of FreiburgFreiburgGermany Servizio Psichiatrico del Comprensorio Sanitario di Bolzano BolzanoItaly Department of Psychiatry Psychotherapy and PsychosomaticsUniversity Hospital of WürzburgGermany Department of Psychiatry and Psychotherapy Medical Center-University of FreiburgFaculty of MedicineUniversity of FreiburgFreiburgGermany Psychiatric Hospital KaufbeurenGermany Department of Child and Adolescent Psychiatry Psychosomatics and PsychotherapyCenter of Mental HealthUniversity Hospital of WürzburgGermany Federal Institute for Drugs and Medical Devices(BfArM) BonnGermany Department of Psychiatry Psychotherapy and PsychosomaticsRWTH Aachen UniversityAachenand JARA–Translational Brain MedicineAachenGermany Clinical Pharmacology Department of Psychiatry and Psychotherapy and Department of Pharmacology and ToxicologyUniversity of RegensburgRegensburgGermany Department of Psychiatry and Psychosomatics University of G ttingenG ttingenGermany Psychiatric Hospital Vitos KlinikEichbergEltvilleGermany Center of Epilepsy BielefeldGermany Medical Laboratory Stein Limbach GroupM nchengladbachGermany Psychiatric Hospital K nigsfeldenBruggAargauSwitzerland Institute of Psychological Medicine Haag in OberbayernGermany Danuviuskliniken Psychiatric HospitalPfaffenhofenGermany Department of Psychiatry and Psychotherapy University of TübingenTübingenGermany Psychiatric Hospitals Oberberggruppe BerlinGermany Psychiatric Hospital Weisser Hirsch DresdenGermany Experimental Psychiatry Unit Department of Psychiatry1Medical University of InnsbruckInnsbruckAustria kbo-Isar-Amper Klinikum München-Ost Psychiatric HospitalMunich-HaarGermany Department of

2.2剂量相关参考浓度范围对于TDM结果的解释,除了治疗参考浓度范围外还有另一个浓度范围,即所谓的剂量相关参考浓度范围。治疗参考浓度范围的应用是药效动力学问题,而剂量相关参考浓度范围的运用是药代动力学问题。后者比较的是测得的... 详细信息

2.2剂量相关参考浓度范围对于TDM结果的解释,除了治疗参考浓度范围外还有另一个浓度范围,即所谓的剂量相关参考浓度范围。治疗参考浓度范围的应用是药效动力学问题,而剂量相关参考浓度范围的运用是药代动力学问题。后者比较的是测得的药物浓度与理论预期药物浓度范围。参照药代动力学研究,优先考虑没有合并用药或药物基因组异常的患者群(“正常”患者),在日维持剂量(Daily maintenance dose,D m)、给药间隔(Dosing interval,d i)、总清除率(Total clearance,CL)和生物利用度(Bioavailability,F)已知情况下,某种药物在某个“正常”患者体内的预期平均稳态浓度(Average steady-state concentration,C av)可通过下面的公式计算。

关键词：治疗药物监测药效动力学给药间隔维持剂量生物利用度药物浓度药代动力学合并用药

神经精神药理学治疗药物监测共识指南:2017版

在线全文

学校读者我要写书评

暂无评论

实用药物与临床 2022年第1期25卷 1-20页

作者： C.Hiemke N.Bergemann H.W.Clement a.conca J.Deckert K.Domschke G.Eckermann K.Egberts M.Gerlach C.Greiner G.Gründer E.Haen U.Havemann-Reinecke G.Hefner R.Helmer G.Janssen E.Jaquenoud G.Laux T.Messer R.M ssner M.J.Müller M.Paulzen B.Pfuhlmann P.Riederer A.Saria B.Schoppek G.Schoretsanitis M.Schwarz M.Silva Gracia B.Stegmann W.Steimer J.C.Stingl M.Uhr S.Ulrich S.Unterecker R.Waschgler G.Zernig G.Zurek P.Baumann 李文标(主译) 果伟(译) 贺静(译) 鲍爽(译) 路钊(译) 牛梦溪(译) 阮灿军(译) 臧彦楠(译) 王勇(译) 张玲(译) 刘辰庚(译) 李洁(译) 汤宜朗(审校) 王传跃(审校) 王刚(审校) Department of Psychiatry and Psychotherapy University Medical Center of MainzMainzGermany Institute of Clinical Chemistry and Laboratory Medicine University Medical Center of MainzMainzGermany Kitzberg Hospitals Center for Psychosomatic Medicine and PsychotherapyBad MergentheimGermany Department of Child and Adolescent Psychiatry University of FreiburgFreiburgGermany Servizio Psichiatrico del Comprensorio Sanitario di Bolzano BolzanoItaly Department of Psychiatry Psychotherapy and PsychosomaticsUniversity Hospital of WürzburgGermany Department of Psychiatry and Psychotherapy Medical Center-University of FreiburgFaculty of MedicineUniversity of FreiburgFreiburgGermany Psychiatric Hospital KaufbeurenGermany Department of Child and Adolescent Psychiatry Psychosomatics and PsychotherapyCenter of Mental HealthUniversity Hospital of WürzburgGermany Federal Institute for Drugs and Medical Devices(BfArM) BonnGermany Department of Psychiatry Psychotherapy and PsychosomaticsRWTH Aachen UniversityAachenand JARA–Translational Brain MedicineAachenGermany Clinical Pharmacology Department of Psychiatry and Psychotherapy and Department of Pharmacology and ToxicologyUniversity of RegensburgRegensburgGermany Department of Psychiatry and Psychosomatics University of G ttingenG ttingenGermany Psychiatric Hospital Vitos KlinikEichbergEltvilleGermany Center of Epilepsy BielefeldGermany Medical Laboratory Stein Limbach GroupM nchengladbachGermany Psychiatric Hospital K nigsfeldenBruggAargauSwitzerland Institute of Psychological Medicine Haag in OberbayernGermany Danuviuskliniken Psychiatric HospitalPfaffenhofenGermany Department of Psychiatry and Psychotherapy University of TübingenTübingenGermany Psychiatric Hospitals Oberberggruppe BerlinGermany Psychiatric Hospital Weisser Hirsch DresdenGermany Experimental Psychiatry Unit Department of Psychiatry1Medical University of InnsbruckInnsbruckAustria kbo-Isar-Amper Klinikum München-Ost Psychiatric HospitalMunich-HaarGermany Department of

治疗药物监测(Therapeutic Drug Monitoring,TDM)通过定量测定和解释血药浓度以优化药物治疗。TDM着眼于药代动力学的个体差异,使个体化药物治疗成为可能。在精神病学和神经病学领域中,有可能明显获益于TDM的主要患者群体包括少年儿童... 详细信息

治疗药物监测(Therapeutic Drug Monitoring,TDM)通过定量测定和解释血药浓度以优化药物治疗。TDM着眼于药代动力学的个体差异,使个体化药物治疗成为可能。在精神病学和神经病学领域中,有可能明显获益于TDM的主要患者群体包括少年儿童、孕妇、老年患者、智障患者、药物滥用者、涉法精神病患者、已知或怀疑药代动力学异常的患者以及合并躯体疾病影响药代动力学的患者。常规剂量下治疗无效,用药依从性难以判断,药物耐受性不佳,以及可能存在药代动力学方面的药物-药物相互作用等情况都是治疗药物监测的典型指征。然而,只有将TDM充分整合到临床治疗过程中,才能发挥其优化药物治疗的潜在优势。为了向临床医生和实验室提供有效的TDM信息,神经精神药理学与药物精神病学协会(Arbeitsgemeinschaft für Neuropsychopharmakologie und Pharmakopsychiatrie,AGNP)的TDM专家组在2004年发表了第一版《精神科治疗药物监测指南》。2011年进行了更新之后,现在再次更新。遵循新版指南,可能会改善神经精神药物治疗的效果,加快很多患者的康复,并降低医疗费用。

关键词：抗凝药物妊娠期静脉血栓栓塞疾病抗抑郁药抗癫痫药抗帕金森病药抗精神病药血药浓度共识指南药物分析基因型分析神经药物遗传药理学药代动力学表型分析血浆药物浓度精神药物参考范围血清药物浓度治疗药物监测治疗窗

Identifiability and Stability of an Inverse Problem Involving a Fredholm Equation

在线全文

学校读者我要写书评

暂无评论

Chinese Annals of Mathematics,Series B 2015年第5期36卷 737-762页

作者： Carlos conca Rodrigo LECAROS Jaime H.ORTEGA Lionel ROSIER Centro de Modelamiento Matematico and Departamento de Ingenier?a Matematica Universidad de Chile (UMI CNRS 2807) Avda Beauchef 851 Edificio Norte Casilla 170-3 Correo 3 Santiago 8370459Chile Centre Automatique et Systemes MINES Paris Tech PSL Research University

The authors study a linear inverse problem with a biological interpretation,which is modelled by a Fredholm integral equation of the first kind, where the kernel is represented by step functions. Based on different as... 详细信息

关键词： Fredholm方程可识别性稳定性第一类Fredholm积分方程反问题生物学逆问题函数表

Hepatic steatosis in overweight/obese females: New screening method for those at risk

在线全文

学校读者我要写书评

暂无评论

World Journal of Gastroenterology 2009年第45期15卷 5693-5699页

作者： Giovanni Tarantino Genoveffa Pizza Annamaria Colao Fabrizio Pasanisi Paolo conca Patrizia Colicchio Carmine Finelli Franco Contaldo Carolina Di Somma Silvia Savastano Department of Clinical and Experimental Medicine Federico Ⅱ University Medical School of Naples Department of Molecular and Clinical Endocrinology and Oncology Section of Endocrinology Federico Ⅱ University Medical School of Naples

AIM: To identify which parameters could help to distinguish the "metabolically benign obesity", which is not accompanied by insulin resistance (IR) and early ***: Eighty two of 124 overweight/obese females formed the study population, which was divided into two groups (52 and 30 subjects, respectively) with and without IR according to a HO meostatic Metabolic Assessment (HOMA) cut-off of 2, and were studied in a cross-sectional manner. The main outcome measures were waist circumference, serum uric acid, high-density lipoprotein-cholesterol and triglycerides, alanine amino-transferase, blood pressure and the two imaging para-meters, hepatic steatosis and longitudinal diameter of the spleen, which were measured in relation to the presence/absence of IR. RESULTS: A variable grade of visceral obesity was observed in all subjects with the exception of *** of a severe grade was represented more in the group of IR individuals (P = 0.01). Hepatic steatosis, revealed at ultrasound, was more pronounced in IR than in non-IR subjects (P = 0.005). The two groups also demonstrated a clear difference in longitudinal spleen diameter and blood pressure, with raised and signif icant values in the IR group. Metabolic syndrome was frequent in the IR group, and was not modified when adjusted for menopause (P = 0.001). At linear regression, the β values of waist circumference and body mass index predicting HOMA were 0.295, P = 0.007 and 0.41, P = 0.0001, respectively. Measures of spleen longitudinal diameter were well predicted by body mass index (BMI) values, β = 0.35, P = 0.01, and by HOMA, β = 0.41, P = 0.0001. Blood pressure was predicted by HOMA values, β = 0.39, P = 0.0001). HOMA and hepatic steatosis were highly associated (rho = 0.34, P = 0.002). Interestingly, IR patients were almost twice as likely to have hepatic steatosis as non-IR patients. Among the MS criteria, blood pressure was very accurate in identifying the presence of IR (AUROC for systo

关键词： Body mass index Cardiovascular disease Fatty liver Insulin resistance Metabolic f itness Obesity

Flow cytometry assay of myeloid dendritic cells (mDCs)in peripheral blood during acute hepatitis C:Possible pathogenetic mechanisms

在线全文

维普期刊数据库

学校读者我要写书评

暂无评论

World Journal of Gastroenterology 2006年第7期12卷 1105-1109页

作者： Alessandro Perrella Luigi Atripaldi Pasquale Bellopede Tommaso Patarino Costanza Sbreglia Giovanni Tarantino Paolo Sorrentino Paolo conca Luca Ruggiero Oreste Perrella Department Infectious Disease and Immunology Hospital D.CotugnoNaplesItaly Department Institute for Cancer Genetics Columbia University

瞄准：到驴骨髓的的树枝状的房间(CD11c+) 的表示子集在在感染的自然科学的尖锐 HCV 肝炎和它的可能的参与期间。方法：我们与尖锐丙肝(AHC )( 组 A ) 注册了 11 个病人，有尖锐肝炎 A (啊哈) 的 10 个病人(同样易传染的控制 -- 组 B )... 详细信息

瞄准：到驴骨髓的的树枝状的房间(CD11c+) 的表示子集在在感染的自然科学的尖锐 HCV 肝炎和它的可能的参与期间。方法：我们与尖锐丙肝(AHC )( 组 A ) 注册了 11 个病人，有尖锐肝炎 A (啊哈) 的 10 个病人(同样易传染的控制 -- 组 B ) 并且在这的 10 个健康施主(组 C ) 学习。所有病人经历了选择流动血细胞计数 gating 策略估计骨髓的的树枝状的房间(mDCs ) 的外部数字在尖锐肝炎期间理解可能的角色和差别。结果：有尖锐 HCV 肝炎的 11 个病人中的八个没与健康个人相比显示出 mDCs 的任何增加，当 mDCs 的重要减少在绝对房间计数被发现时(z =-2.37；P<0.05 ) 并且百分比(z =-2.30；P<0.05 ) 同样与啊哈相比。相反，留下组 A 的三个病人有是的一个更高的 mDCs 数字和百分比发生在组 B。在六个月以后，有趣地，那些病人没证明 mDCs 子集的任何增加长期地被感染。当三在 HAV 急性感染随外部 mDCs 的增加使遭到，，时，解决了病。结论：mDCs 的增加的缺乏可能在尖锐丙肝期间是涉及感染的 chronicization 的一个重要因素。

关键词：血细胞记数骨髓树状细胞外周血丙型肝炎

Does protracted antiviral therapy impact on HCV-related liver cirrhosis progression?

在线全文

维普期刊数据库

学校读者我要写书评

暂无评论

World Journal of Gastroenterology 2007年第36期13卷 4903-4908页

作者： Giovanni Tarantino Antonio Gentile Domenico Capone Vincenzo Basile Marianna Tarantino Matteo Nicola Dario Di Minno Alberto Cuocolo Paolo conca Department of Clinical and Experimental Medicine Federico Ⅱ University Medical School of Naples Naples 80131 Italy Department of Biomorphological and Functional Sciences Pharmacology Section of Neuroscience Department Federico Ⅱ University Medical School of Naples Naples 80131 Italy

AIM: To study the outcomes of patients with compensated hepatitis C virus-related cirrhosis. METHODS: Twenty-four grade A5 and 11 grade A6 of Child-Pugh classification cirrhotic patients with active virus replication, treated for a mean period of 31.3 ± 5.1 mo with moderate doses of interferon-alpha and ribavirin, were compared to a cohort of 36 patients with similar characteristics, without antiviral treatment. Salivary caffeine concentration, a liver test of microsomal function, was determined at the starting and thrice in course of therapy after a mean period of 11 ± 1.6 mo, meanwhile the resistive index of splenic artery at ultra sound Doppler, an indirect index of portal hypertension, was only measured at the beginning and the end of study. RESULTS: Eight out of the 24 A5- (33.3%) and 5 out of the 11 A6- (45.45%) treated-cirrhotic patients showed a significant improvement in the total overnight salivary caffeine assessment. A reduction up to 20% of the resistive index of splenic artery was obtained in 3 out of the 8 A5- (37.5%) and in 2 out of the 5 A6- (40%) cirrhotic patients with an improved liver function, which showed a clear tendency to decrease at the end of therapy. The hepatitis C virus clearance was achieved in 3 out of the 24 (12.5%) A5- and 1 out of the 11 (0.091%) A6-patients after a median period of 8.5 mo combined therapy. In the cohort of non-treated cirrhotic patients, not only the considered parameters remained unchanged, but 3 patients (8.3%) had a worsening ofthe Child-Pugh score (P = 0.001).CONCLUSION: A prolonged antiviral therapy with moderate dosages of interferon-alpha and ribavirin shows a trend to stable liver function or to ameliorate the residual liver function, the entity of portal hypertension and the compensation status at acceptable costs.

关键词：肝硬化丙型肝炎病毒感染治疗方法

静止期的非酒精性脂肪肝:一项临床组织学研究

在线全文

维普期刊数据库

学校读者我要写书评

暂无评论

世界核心医学期刊文摘（胃肠病学分册） 2005年第4期1卷 58-59页

作者： Sorrentino P. Tarantino G. conca P. 姜志茹

We studied the prevalence of non-alcoholic fatty liver disease and non-alcoholic-steatohepatitis in patients with metabolicsyndrome but normal liver enzymes. The histological findings of patients with normal liver enzymes and non-alcoholic-steatohepatitis were compared with those of a control-group with persistently abnormal liver enzymes. Patients presenting with normal liver enzymes were enrolled in the study and underwent liver biopsy. Prevalence of non-alcoholic-steatohepatitis and risk factors for fibrosis and cirrhosis were evaluated. Data from a control-group with non-alcoholic-steatohepatitis and abnormal liver enzymes were used to compare the histological findings. Fifty-eight of the 80 patients enrolled had varying degrees of non-alcoholic steatohepatitis, of these 26 had fibrosis and 8 silent cirrhosis. The association of metabolic-syndrome, female-sex, a long-history of obesity and body mass index > 45 were considered to be independent risk-factors for fibrosis. Comparing the histological findings of cases and controls we found a similar severity of steatosis and fibrosis, with a greater prevalence of ballooning degeneration and glycogenated-nuclei rather than lobular-inflammation. In the subjects selected according to our criteria, liver enzyme levels could not be used as surrogate markers of non-alcoholic-steatohepatitis. Histological hallmarks of patients with metabolic-syndrome, normal liver enzymes and non-alcoholic-steatohepatitis consist to a lesser degree of lobular-inflammation and a more severe ballooning and glycogenated-nuclei.

关键词：酒精性脂肪肝静止期组织学研究脂肪变性纤维化程度代谢综合征气球样变性持续性

Penile prosthesis: Patient satisfaction, use and preference for malleable vs inflatable

在线全文

学校读者我要写书评

暂无评论

World Journal of Clinical Urology 2014年第2期3卷 134-138页

作者： Ramón Rogel Bertó Jose Daniel López-Acón Saturnino Luján Marco Domingo Guzmán Ordaz Jurado Francisco Delgado Oliva María Angeles conca Baenas Francisco Boronat Tormo Urology Department University and Polytechnic Hospital La Fe46026 ValenciaSpain

AIM: To evaluate and compare long-term patient satisfaction and use after either malleable penile prosthesis(MPP) or inflatable penile prosthesis(IPP) implantation. METHODS: we present a retrospective unicenter study of 108 patients implanted with either 2 or 3-piece American Medical System^(TM)(AMS^(TM)) or Coloplast^(TM) inflatable penile prosthesis(AMS 700CX^(TM), AMS 700CXR^(TM), AMS Ambicor^(TM) or Coloplast TITAN^(TM)) or malleable(AMS Spectra^(TM) or Coloplast Genesis^(TM)) in our Centre between 1993 and 2011. We collected data from the medical record including follow-up, age and type of prosthesis. We used a four-question telephone surveydesigned ad hoc by urologist in our Department, with three multiple choice questions and a grading answer. After verbal consent was obtained, proposed questions concerned global satisfaction regarding to the procedure, quality of sexual intercourses graded from 0 to 10, frequency of sexual intercourse and about undergoing the same procedure again. SPSS^(TM) version 20.0 was used for the descriptive analysis of the data. RESULTS: Sixty seven(64%) patients underwent a MPP and 41(36%) an IPP. The mean age was 52.6 ± 3.6 years in the MPP group and 57.2 ± 2.8 years in the IPP group(P = 0.02). Total respond rate was 55.5%(60/108). Twenty six out of 33 MPP patients(78.9%) and 19 of the 27 IPP subjects(70.3%) were satisfied or very satisfied with the procedure. The quality of sexual intercourse was rated 7.13 ± 0.39 points in the MPP group and 6.16 ± 0.47 points in the IPP group. Frequency of sexual intercourse was 1 or more times per week in 15(46.9%) patients with MPP and in 12(46.1%) of the IPP patients. Twenty-eight(84.9%) patients who received a MPP would undergo the procedure for the same device again as well as 24(88.9%) of the IPP group. There were no statistical differences between groups regarding the four items in the ***: Patients show high satisfaction rate and no statistical differences exist regarding to

关键词： Penile prosthesis Patient satisfaction Erectile dysfunction Medical survey

AGNP精神科治疗药物监测共识指南：2011

在线全文

维普期刊数据库

学校读者我要写书评

暂无评论

实用药物与临床 2016年第10期19卷 1193-1218页

作者： Hiemke C Baumann P Bergemann N conca A Dietmaier O Egberts K Fric M Gerlach M Greiner C Gründer G Haen E Havemann-Reinecke U Jaquenoud Sirot E Kirchherr H Laux G Lutz UC Messer T Müller MJ Pfuhlmann B Rambeck B Riederer P Schoppek B Stingl J Uhr M Ulrich S Waschgler R Zernig G 李文标(译) 果伟(译) 阮灿军(译) 贺静(译) 汤宜朗(审校) 王传跃(审校) Department of Psychiatry and Psychotherapy University MedicalCenter of MainzGermany Department of Psychiatry University of LausannePrilly-LausanneSwitzerland Psychiatric Hospital Bad ArolsenGermany Psychiatric Hospital BolzanoItaly Psychiatrc Hospital WeinsbergGermany Department Child and Adolescent Psychiatry University Hospital of WurzburgGermany Kliniken des Bezirks Oberbayern(kbo)Salzach-Inn-Klinikum Was-serburg a.InnGermany Federal Institute for Drugs and Medical Devices(BfArM) BonnGermany Department of Psychiatry and Psychotherapy University of AachenGermany Clinical Pharmacology Department of Psychiatry and Psychoso-maticsUniversity of RegensburgGermany Department of Psychiatry and Psychosomatics University of GotingenGermany Psychiatric Hospital KonigsfeldenBruggAargauSwitzerland Medical Laboratory Bremen Germany Department of Psychiatry and Psychotherapy University of TubingenGermany Psychiatric Hospital PfaffenhofenGermany Psychiatric Hospital Marburg and GieβenGermany Department of Psychiatry Psychotherapy and PsychosomaticsUniversity Hospital of WurzburgGermany Center of Epilepsy BielefeldGermany Psychiatric Hospital HaarGermany Department of Pharmacology of Natural Products and ClinicalPharmacology University of UlmGermany Max Planck Institute of Psychiatry MunichGermany Aristo Pharma GmbH BerlinGermany Psychiatric Hospital FeldkirchAustria Experimental Psychiatry Unit Department of Psychiatry and PsychotherapyMedical University of InnsbruckAustria 首都医科大学附属北京安定医院北京 Emory University School of Medicine AtlantaUSA

治疗药物监测(Therapeutic drug monitoring,TDM),如通过定量测定血清或血浆药物浓度指导用药剂量优化,已经成为对患者进行精神药物治疗的很有价值的工具。在患者用药依从性难以判断、药物耐受性不佳、治疗剂量下无效以及可能存在药代... 详细信息

治疗药物监测(Therapeutic drug monitoring,TDM),如通过定量测定血清或血浆药物浓度指导用药剂量优化,已经成为对患者进行精神药物治疗的很有价值的工具。在患者用药依从性难以判断、药物耐受性不佳、治疗剂量下无效以及可能存在药代动力学药物-药物相互作用等情况下,测定药物浓度是很有用的。在精神科,有可能明显获益于TDM的主要患者群体包括儿童、孕妇、老年患者、智力障碍患者、涉及司法的患者、已知或怀疑携带药代动力学相关基因变异的患者,以及合并躯体疾病影响药代动力学的患者。然而,只有将TDM充分整合到临床治疗过程中去,才能发挥其优化药物治疗的潜在优势。为了促进TDM的合理应用,神经精神药理学与药物精神病学协会(Arbeitsgemeinschaft für Neuropsychopharmakologie und Pharmakopsychiatrie,AGNP)的TDM专家组在2004年发表了精神药物治疗药物监测指南。之后,随着知识不断更新,又有许多可能需要进行TDM的新药上市。因此,本次更新将神经精神药物的种类扩展到了128种,并将其TDM必要性划分为从"强烈推荐"到"可能有用"的四个等级。经过大量细致且全面的文献检索与分门别类的汇总整理,将基于循证医学理念的"治疗参考浓度范围"和"剂量相关参考浓度范围"呈现给大家。本共识指南引入了"实验室警戒浓度"的新概念,即实验室需要马上告知治疗医生的药物浓度上限。本共识指南还给出了诸如药物作为细胞色素P450酶的底物和抑制剂的性质,代谢物与母药浓度比值的常见范围,以及与结果解释相关的内容,还提供了何时将TDM与遗传药理学检测相结合的建议。遵循本指南,有助于改善许多患者精神药物治疗的效果,特别是那些存在药代动力学异常的患者。TDM是一门交叉学科,有时针对看起来不一致的数据,需要多学科坦诚地讨论,只有这样,患者才能从这种合作中获益。

关键词：共识指南药物分析药代动力学精神药物治疗参考浓度范围治疗药物监测治疗窗