Liamsuwan Sahas, Jaiweerawattana Ulailuk
Division of Child Neurology, Queen Sirikit National Institute of Child Health, Department of Medical Services, Ministry of Public Health, College of Medicine, Rangsit University, Bangkok, Thailand.
J Med Assoc Thai. 2011 Aug;94 Suppl 3:S172-7.
To study the correlation between serum and salivary phenytoin concentration in Thai epileptic children.
Children aged 5 to 12 years with diagnosed epilepsy who received phenytoin monotherapy seen in the neurological clinic at Queen Sirikit National Institute of Child Health were studied. The recruited patients were required to have good compliance, normal albumin level, and no evidence of cancer, HIV infection, hepatic, renal and salivary glands disease. Blood and saliva samples were collected and measured phenytoin level by fluorescence-polarization immunoassay technique.
Thirty patients, 19 males and 11 females, were studied. The average (mean +/- SD) age and weight were 8.24 +/- 2.09 years and 27.76 +/- 9.86 Kilograms. Both serum and salivary phenytoin levels correlated with phenytoin doses as exponential type (R2 = 0.4188, 0.3682, respectively). Equations for describing serum and salivary phenytoin levels by phenytoin dose were y = 0.7403e(0.3952x) and y = 0.1431e(0.3072x) respectively. Serum and salivary phenytoin levels were closely correlated as linear type (R = 0.880, R2 = 0.967). The obtained equation of this relationship was y = 10.165x, where y = serum phenytoin level and x = salivary phenytoin level. Adverse drug reactions were found in 5 patients (6.6%), horizontal nystagmus 2 cases, hirsutism 2 cases and gingival hyperplasia 1 case.
High correlation between serum and salivary phenytoin levels supported the use of saliva instead of blood for phenytoin monitoring in Thai children which were difficult in blood collection and had psychological trauma. The obtained equations in the present study could be applied for adjusting the dosage regimen and monitoring by using salivary phenytoin level in clinical practice.
研究泰国癫痫儿童血清和唾液中苯妥英浓度之间的相关性。
对在诗丽吉王后国家儿童健康研究所神经科门诊就诊、年龄在5至12岁、确诊癫痫且接受苯妥英单药治疗的儿童进行研究。招募的患者要求依从性良好、白蛋白水平正常，且无癌症、HIV感染、肝脏、肾脏及唾液腺疾病的证据。采集血液和唾液样本，采用荧光偏振免疫测定技术测定苯妥英水平。
共研究了30例患者，其中男性19例，女性11例。平均（均值±标准差）年龄和体重分别为8.24±2.09岁和27.76±9.86千克。血清和唾液中苯妥英水平均与苯妥英剂量呈指数关系（R²分别为0.4188和0.3682）。用苯妥英剂量描述血清和唾液中苯妥英水平的方程分别为y = 0.7403e(0.3952x)和y = 0.1431e(0.3072x)。血清和唾液中苯妥英水平呈线性密切相关（R = 0.880，R² = 0.967）。该关系的方程为y = 10.165x，其中y为血清苯妥英水平，x为唾液苯妥英水平。5例患者（6.6%）出现药物不良反应，水平性眼球震颤2例，多毛症2例，牙龈增生1例。
血清和唾液中苯妥英水平高度相关，支持在泰国儿童中用唾液替代血液进行苯妥英监测，因为这些儿童采血困难且有心理创伤。本研究中得到的方程可用于临床实践中调整用药方案及通过唾液苯妥英水平进行监测。
