Tal A, Aviram M, Gorodischer R
Division of Pediatrics, Soroka Medical Center, Beer-Sheva, Israel.
J Allergy Clin Immunol. 1990 Aug;86(2):238-43.
Sustained-release theophylline (SRT) therapy was monitored in ambulatory children with asthma by measuring theophylline in citric acid-stimulated saliva. Ninety-six around-the-clock saliva theophylline profiles were performed in 59 children (median age, 8.3 years) under routine life conditions. Five to seven stimulated saliva samples were collected by parents at home during a 24-hour period. Highest (Cmax) and lowest (Cmin) saliva theophylline concentrations (Sal-TC) were not consistently found after or before medication, respectively. Cmax occurred during morning hours (before or after medication) in 82% of patients. Cmax was found immediately before morning or evening dose in as many as 25% of patients. Cmin occurred in 70% of children during evening hours. Cmin was found 4 hours after morning or evening dose in 19% of patients. Excessive fluctuation in Sal-TC between pre- and post-SRT doses during both day and night hours occurred in six patients (286% +/- 87% (mean +/- SD)). Marked circadian variation in Sal-TC was disclosed in 23% of children. The first profile performed was therapeutically satisfactory in only 39% of patients; satisfactory profiles were achieved in other children after changing daily SRT dose or dosing interval. Determination of theophylline concentration in stimulated saliva specimens obtained frequently during a 24-hour period and under routine life conditions is practical and extremely valuable for close monitoring and individualization of theophylline therapy in ambulatory children with asthma.
通过测量柠檬酸刺激唾液中的茶碱水平，对门诊哮喘儿童的缓释茶碱（SRT）治疗进行监测。在59名儿童（中位年龄8.3岁）的日常生活条件下，进行了96次24小时唾液茶碱水平监测。家长在24小时内在家中采集5至7份刺激唾液样本。唾液茶碱浓度最高值（Cmax）和最低值（Cmin）并非分别一致地出现在用药后或用药前。82%的患者Cmax出现在上午时段（用药前或用药后）。多达25%的患者Cmax出现在上午或晚上用药前即刻。70%的儿童Cmin出现在晚上时段。19%的患者Cmin出现在上午或晚上用药后4小时。6名患者（286%±87%（均值±标准差））在白天和夜间SRT剂量前后唾液茶碱浓度出现过度波动。23%的儿童唾液茶碱浓度呈现明显的昼夜变化。首次进行的监测仅在39%的患者中显示治疗效果满意；其他儿童在改变每日SRT剂量或给药间隔后达到了满意的监测结果。在24小时内的日常生活条件下频繁采集刺激唾液标本测定茶碱浓度，对于密切监测门诊哮喘儿童的茶碱治疗并实现个体化治疗是切实可行且极具价值的。
