双相情感障碍治疗药物监测中的总丙戊酸盐与游离丙戊酸盐:横断面研究

IF 2.8 3区 医学 Q2 PSYCHIATRY
Mullezhath Babu Nimesh Krishna MD, Jyothsna Chinnapura Seetharam MD, Archana Mishra DM, Rituparna Maiti MD, Biswa Ranjan Mishra MD, Anand Srinivasan DM
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引用次数: 0

摘要

引言 几十年来,关于在治疗药物监测(TDM)中观察血清总丙戊酸钠水平还是游离丙戊酸钠水平的争论一直悬而未决。本研究旨在评估总浓度与游离丙戊酸钠水平之间的一致性,以及在 TDM 中使用一种方法比使用另一种方法的优势。 方法 本横断面研究针对 93 名双相情感障碍患者。通过类内相关系数、Bland Altman 分析和 Lin 一致性分析来评估总浓度和游离丙戊酸钠浓度之间的一致性。建立了线性和多项式模型来评估两种测量值之间的关系。为了比较杨氏躁狂评分量表(YMRS)区分缓解与非缓解的准确性,进行了接收者操作特征分析。 结果 类内相关系数和林氏一致性相关系数分别为 0.491 (p = .002) 和 0.055 (95% CI:0.037, 0.073)。Bland Altman 分析显示存在比例偏差。根据总丙戊酸盐的数据,发现二阶多项式模型是预测游离丙戊酸盐的最佳拟合模型,根据白蛋白水平调整后,81.4%的游离丙戊酸盐变异可以得到解释。在区分缓解与非缓解方面,总丙戊酸钠的曲线下面积为 0.60,而游离丙戊酸钠的曲线下面积为 0.56,但两种 ROC 分析之间的比较并无统计学意义。 结论 与总丙戊酸盐水平相比,游离丙戊酸盐没有任何额外优势;因此,总丙戊酸盐水平可继续用作药物监测的标志物。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Total valproate versus free valproate in therapeutic drug monitoring for bipolar disorder: A cross-sectional study

Introduction

The debate about observing total versus free serum valproate levels for therapeutic drug monitoring (TDM) has been unresolved for decades. This study was planned to assess the agreement between the total versus free valproate levels and the advantage of one method over the other in TDM.

Methods

The present cross-sectional study was done on 93 patients with bipolar disorder. The intraclass correlation coefficient, Bland Altman analysis, and Lin's concordance analysis were done to assess the agreement between the total and free valproate concentrations. Linear and polynomial models were constructed to evaluate the relation between the two measurements. Receiver operating characteristics analysis was done to compare the accuracy for differentiating remission from non-remission on Young's mania rating scale (YMRS).

Results

The intraclass correlation coefficient and Lin's concordance correlation coefficient were 0.491 (p = .002) and 0.055 (95% CI:0.037, 0.073), respectively. Bland Altman's analysis showed proportional bias. A polynomial model of second order was found to be the best fit for the prediction of free valproate from the data for total valproate, and 81.4% of the variability in free valproate could be explained when adjusted for albumin levels. The area under the curve for total valproate was 0.60 when compared to free valproate 0.56 for differentiating between remission and non-remission, but the comparison between the two ROC analyses was not statistically significant.

Conclusion

Free valproate does not provide any added advantage over the total valproate levels; hence, total valproate levels may continue to be used as the marker for drug monitoring.

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来源期刊
CiteScore
7.80
自引率
0.00%
发文量
17
审稿时长
>12 weeks
期刊介绍: Asia-Pacific Psychiatry is an international psychiatric journal focused on the Asia and Pacific Rim region, and is the official journal of the Pacific Rim College of Psychiatrics. Asia-Pacific Psychiatry enables psychiatric and other mental health professionals in the region to share their research, education programs and clinical experience with a larger international readership. The journal offers a venue for high quality research for and from the region in the face of minimal international publication availability for authors concerned with the region. This includes findings highlighting the diversity in psychiatric behaviour, treatment and outcome related to social, ethnic, cultural and economic differences of the region. The journal publishes peer-reviewed articles and reviews, as well as clinically and educationally focused papers on regional best practices. Images, videos, a young psychiatrist''s corner, meeting reports, a journal club and contextual commentaries differentiate this journal from existing main stream psychiatry journals that are focused on other regions, or nationally focused within countries of Asia and the Pacific Rim.
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