Perry P J, Miller D D, Arndt S V, Cadoret R J
Department of Psychiatry, College of Medicine, University of Iowa, Iowa City.
Am J Psychiatry. 1991 Feb;148(2):231-5. doi: 10.1176/ajp.148.2.231.
Clozapine, an atypical antipsychotic, has been estimated to be effective in 30% of treatment-refractory schizophrenic patients. The authors hypothesized that if a dose-response relationship was obvious for this drug, the response rate could be significantly amplified.
Following an 8-24-day dose titration phase, 29 inpatients with treatment-resistant schizophrenia diagnosed according to DSM-III-R were given a clozapine dose of approximately 400 mg/day for 4 weeks; blood samples were obtained weekly during this period.
A receiver operator curve demonstrated that the threshold clozapine plasma concentration for therapeutic response was 350 ng/ml. Sixty-four percent of the patients with clozapine plasma concentrations greater than 350 ng/ml responded, whereas only 22% of the patients with concentrations less than 350 ng/ml responded.
Use of clozapine blood levels as a predictor for treatment response in treatment-refractory schizophrenic patients appears worthwhile, since the measurement's sensitivity for response was 64% and the specificity for nonresponse was 78%.
氯氮平作为一种非典型抗精神病药物，据估计在30%的难治性精神分裂症患者中有效。作者推测，如果该药物存在明显的剂量-反应关系，那么有效率可能会显著提高。
在8至24天的剂量滴定阶段后，根据《精神疾病诊断与统计手册第三版修订本》（DSM-III-R）诊断为难治性精神分裂症的29名住院患者接受了为期4周、每日约400毫克氯氮平的治疗；在此期间每周采集血样。
一条受试者工作特征曲线表明，治疗反应的氯氮平血浆浓度阈值为350纳克/毫升。氯氮平血浆浓度大于350纳克/毫升的患者中有64%有反应，而浓度小于350纳克/毫升的患者中只有22%有反应。
将氯氮平血药浓度作为难治性精神分裂症患者治疗反应的预测指标似乎是值得的，因为该测量对反应的敏感性为64%，对无反应的特异性为78%。
