CAJ | 학술논문

目的比较碳青霉烯类抗菌药比阿培南与美罗培南对丙戊酸（ VPA）血药浓度的影响。方法收集2008年1月至2013年12月在苏州市立医院住院期间因症状性癫痫并发感染联用VPA和比阿培南或美罗培南患者的病历资料进行回顾性分析，分别纳入比阿培南组和美罗培南组。记录患者一般临床资料、用药情况，比较2组患者联用抗菌药前后的VPA血药浓度、癫痫发作情况以及临床处理措施等。结果共纳入79例患者，其中6例曾间隔至少1个月先后使用美罗培南和比阿培南，因此其应用不同药物期间的各项临床数据分别纳入2组进行分析。比阿培南组37例，美罗培南组48例，2组患者临床资料比较差异无统计学意义。比阿培南组和美罗培南组患者联用抗菌药后VPA血药浓度均显著降低，但比阿培南组 VPA 血药浓度高于美罗培南组[（13.3±6.2）mg／L 比（10.7±7.0）mg／L，P=0.046]，比阿培南组VPA血药浓度平均下降程度低于美罗培南组[（70.6±9.6％）比（78.8±8.8％），P=0.010]。6例先后联用美罗培南和比阿培南的患者，联用2种药物后VPA血药浓度均显著下降，但联用比阿培南期间VPA血药浓度高于联用美罗培南期间。联合用药后比阿培南组癫痫发作率与美罗培南组差异无统计学意义（29.7％比35.4％，P=0.749）。结论比阿培南或美罗培南与VPA联用均可导致VPA血药浓度明显降低。比阿培南对VPA血药浓度的降低程度低于美罗培南，但同样增加癫痫发作风险。
목적비교탄청매희류항균약비아배남여미라배남대병무산（ VPA）혈약농도적영향。방법수집2008년1월지2013년12월재소주시립의원주원기간인증상성전간병발감염련용VPA화비아배남혹미라배남환자적병력자료진행회고성분석，분별납입비아배남조화미라배남조。기록환자일반림상자료、용약정황，비교2조환자련용항균약전후적VPA혈약농도、전간발작정황이급림상처리조시등。결과공납입79례환자，기중6례증간격지소1개월선후사용미라배남화비아배남，인차기응용불동약물기간적각항림상수거분별납입2조진행분석。비아배남조37례，미라배남조48례，2조환자림상자료비교차이무통계학의의。비아배남조화미라배남조환자련용항균약후VPA혈약농도균현저강저，단비아배남조 VPA 혈약농도고우미라배남조[（13.3±6.2）mg／L 비（10.7±7.0）mg／L，P=0.046]，비아배남조VPA혈약농도평균하강정도저우미라배남조[（70.6±9.6％）비（78.8±8.8％），P=0.010]。6례선후련용미라배남화비아배남적환자，련용2충약물후VPA혈약농도균현저하강，단련용비아배남기간VPA혈약농도고우련용미라배남기간。연합용약후비아배남조전간발작솔여미라배남조차이무통계학의의（29.7％비35.4％，P=0.749）。결론비아배남혹미라배남여VPA련용균가도치VPA혈약농도명현강저。비아배남대VPA혈약농도적강저정도저우미라배남，단동양증가전간발작풍험。
Objective To compare the influence of carbapenems such as biapenem and meropenem on valproic acid( VPA)blood concentration. Methods The clinical data of patients with symptomatic epilepsy and infections who were hospitalized in Suzhou Municipal Hospital during January 2008 to December 2013,and received concomitant therapy with VPA and biapenem or meropenem were collected and analyzed retrospectively. These patients were divided into biapenem group and meropenem group. The information of general clinical data and medication were recorded. VPA blood concentration,seizures and clinical treatment before and after the combination with carbapenems were compared between the two groups. Results A total of 79 cases were enrolled in the analysis. Six patients were treated with meropenem and biapenem successively at more than one month intervals,clinical data during the period of different carbapenems use were included in different groups. There were 37 cases in the biapenem group and 48 cases in the meropenem group;clinical data had no statistical significance between the 2 groups. The VPA blood concentration of biapenem group and meropenem group were significantly decreased. The VPA blood concentrations in biapenem group were higher than that of meropenem group(13. 3 ± 6. 2)mg/L vs(10. 7 ± 7. 0)mg/L,P= 0. 046). The mean decrease of VPA blood concentrations in biapenem group was also less than that of meropenem group(70. 6 ± 9. 6% vs 78. 8 ± 8. 8%,P=0. 010). The VPA blood concentrations of six patients treated with meropenem and biapenem successively were significantly decreased. The blood concentrations were also higher when combined with biapenem compared to meropenem. The rate of seizures had no significant difference between the 2 groups( 29. 7% vs 35. 4%,P =0. 749 ). Conclusions Both biapenem and meropenem could decrease VPA blood concentrations significantly. Biapenem had less impact on VPA blood concentration compared to meropenem,but also increased the risk of seizures.