Jones Mikael D, Ryan Melody, Miles Michael V, Tang Peter H, Fakhoury Toufic A, Degrauw Ton J, Baumann Robert J
University of Kentucky Chandler Medical Center, Lexington, Kentucky 40536, USA.
Ther Drug Monit. 2005 Oct;27(5):576-9. doi: 10.1097/01.ftd.0000171869.56817.ae.
Saliva antiepileptic drug (AED) concentrations strongly correlate with serum concentrations. Saliva collection is painless and noninvasive, and untrained personnel can easily be taught the collection process. Remote patients could mail saliva samples to a laboratory for monitoring, and samples could be obtained in the immediate postictal state to provide a "real-time" concentration. The objectives of this study were to assess the stability of saliva lamotrigine (LMT), levetiracetam (LEV), oxcarbazepine (OXC), topiramate (TPM), and zonsiamide (ZNS) concentrations sent through the United States Postal Service (USPS) and to quantify the amount of time needed for patients and the USPS to return samples to clinic. Saliva samples were obtained from patients currently taking 1 of the targeted AEDs. Samples were split into 2 storage vials. One sample was sealed in an addressed envelope, which the patient mailed from home, whereas the other sample was frozen immediately. Postmark date and day returned were collected for mailed samples. Saliva concentrations were determined using HPLC. Wilcoxon rank sum tests were used to compare the immediately-frozen and mailed sample means. Correlations were determined by the Spearman test. Thirty-seven patients were enrolled in the study. The median time between collection and postmark was 1 day (range 0-6 days); and between collection and receipt was 4 days (range 1-160 days). The mean concentrations for mailed and immediately frozen samples were similar for each AED (P > 0.15). Spearman rank order correlations between mailed and immediately frozen aliquots were strong (LMT rs = 1, LEV rs = 1, OXC rs = 0.964, TPM rs = 0.90, and ZNS rs = 1). Saliva samples mailed by patients maintain stability and can be returned in a reasonable length of time. Further studies are needed to assess patient/caretaker capability of obtaining an adequate sample.
唾液中抗癫痫药物（AED）浓度与血清浓度密切相关。唾液采集无痛且无创，未经培训的人员也能轻松学会采集过程。远程患者可将唾液样本邮寄至实验室进行监测，且可在发作后即刻采集样本以提供“实时”浓度。本研究的目的是评估通过美国邮政服务（USPS）寄送的唾液拉莫三嗪（LMT）、左乙拉西坦（LEV）、奥卡西平（OXC）、托吡酯（TPM）和唑尼沙胺（ZNS）浓度的稳定性，并量化患者和USPS将样本返回诊所所需的时间。从目前正在服用1种目标AED的患者中获取唾液样本。样本被分成2个储存小瓶。一个样本密封在写好地址的信封中，由患者从家中寄出，而另一个样本立即冷冻。记录邮寄样本的邮戳日期和返回日期。使用高效液相色谱法测定唾液浓度。采用Wilcoxon秩和检验比较即刻冷冻样本和邮寄样本的均值。通过Spearman检验确定相关性。37名患者参与了本研究。采集与邮戳日期之间的中位时间为1天（范围0 - 6天）；采集与收到样本之间的中位时间为4天（范围1 - 160天）。每种AED的邮寄样本和即刻冷冻样本的平均浓度相似（P > 0.15）。邮寄样本和即刻冷冻样本等分之间的Spearman秩次相关性很强（LMT rs = 1，LEV rs = 1，OXC rs = 0.964，TPM rs = 0.90，ZNS rs = 1）。患者邮寄的唾液样本保持稳定，且能在合理时间内返回。需要进一步研究以评估患者/护理人员获取足够样本的能力。
