Roberts M A, Caird F I
Age Ageing. 1976 Nov;5(4):214-23. doi: 10.1093/ageing/5.4.214.
Renal clearance of digoxin and creatinine was determined simultaneously on 30 occasions in 28 elderly in-patients on maintenance digoxin therapy. The mean ratio of digoxin to creatinine clearance was 1.04 (+/- S.E.M. 0.08). Multiple 24-hour urinary excretions of digoxin were measured in 10 patients on digoxin on a dose of 0.25 mg/day, four on 0.125 mg/day, and six on 0.0625 mg/day. Mean urinary excretion was 42% of dose per day. Calculated "net biliary clearance" averaged 18 ml/min. Knowledge of the magnitude of renal and net biliary clearance, together with assumed values for fractional absorption allows a relationship between serum digoxin levels and creatinine clearance to be calculated for each dose level. There was reasonable agreement between observed and expected serum digoxin levels in 41 elderly patients in whom creatinine clearance was measured, and in 106 in whom glomerular filtration rate was estimated from serum urea and creatinine concentrations. Quantitation of the kinetics of digoxin in the elderly can make maintenance therapy more rational and therefore safer and more effectove.
对28例接受地高辛维持治疗的老年住院患者，共30次同时测定了地高辛和肌酐的肾清除率。地高辛清除率与肌酐清除率的平均比值为1.04（±标准误0.08）。对10例服用0.25mg/天地高辛的患者、4例服用0.125mg/天地高辛的患者和6例服用0.0625mg/天地高辛的患者，测定了多次24小时地高辛尿排泄量。平均尿排泄量为每日剂量的42%。计算出的“净胆汁清除率”平均为18ml/分钟。了解肾清除率和净胆汁清除率的大小，再结合吸收分数的假定值，就可以计算出每个剂量水平下地高辛血清水平与肌酐清除率之间的关系。在41例测定了肌酐清除率的老年患者以及106例根据血清尿素和肌酐浓度估算了肾小球滤过率的患者中，观察到的和预期的地高辛血清水平之间存在合理的一致性。对老年人地高辛动力学进行定量分析，可以使维持治疗更加合理，从而更安全、更有效。
