Zalzstein Eli, Zucker Nili, Lifshitz Matityhau
Pediatric Cardiology Unit, Division of Pediatrics, Soroka University Medical Center, Beer-Sheva, Israel, and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
Curr Ther Res Clin Exp. 2003 Nov;64(9):743-9. doi: 10.1016/j.curtheres.2003.09.015.
Because of its narrow therapeutic index, therapeutic monitoring of digoxin is important in the management of infants and children receiving the drug for cardiac failure or arrhythmias, or following accidental ingestion. Whether saliva can replace plasma in the therapeutic monitoring of digoxin therapy in children is unclear.
This study assessed the value of determining saliva digoxin concentration in infants, children, and adolescents.
Infants, children, and adolescents receiving digoxin for various indications, whose digoxin dosage had remained unchanged for ≥10 days, and whose compliance was good according to the parents were enrolled. Digoxin concentration was measured in paired specimens of citric acid-stimulated mixed saliva and plasma obtained simultaneously.
Eighteen children (10 boys, 8 girls; mean [SD] age, 42.3 [53.1] months [range, 2 months-14 years]) were included in the study. Digoxin therapy was administered for cardiac failure due to dilated cardiomyopathy in 9 patients (50.0%), ventricular septal defect in 4 (22.2%), supraventricular tachycardia in 3 (16.7%), and after cardiac surgery in 2 (11.1%). Digoxin concentration in the 20 paired specimens obtained varied from 0.0 to 0.92 ng/mL (mean [SD], 0.25 [0.26] ng/mL) in saliva and from 0.27 to 1.54 ng/mL (mean [SD], 0.77 [0.40] ng/mL) in plasma. The mean plasma/saliva digoxin concentration ratio was 2.8.
This study of infants, children, and adolescents receiving digoxin for a variety of indications and whose dose was unchanged for ≥10 days showed that marked individual variability in the saliva/plasma concentration ratio precludes the use of saliva in predicting the plasma digoxin concentration. The value of saliva digoxin (as opposed to plasma digoxin) measurements in the assessment of the cardiac effects of the drug in children remains to be determined.
由于地高辛的治疗指数较窄，因此对于接受该药治疗心力衰竭、心律失常或误服的婴幼儿及儿童，进行地高辛治疗药物监测很重要。目前尚不清楚在儿童地高辛治疗的药物监测中，唾液是否可以替代血浆。
本研究评估了测定婴幼儿、儿童及青少年唾液中地高辛浓度的价值。
纳入因各种适应证接受地高辛治疗、地高辛剂量已维持≥10天不变且据家长反馈依从性良好的婴幼儿、儿童及青少年。同时采集柠檬酸刺激后的混合唾液和血浆配对样本，测定地高辛浓度。
本研究共纳入18名儿童（10名男孩，8名女孩；平均[标准差]年龄为42.3[53.1]个月[范围：2个月至14岁]）。9例（50.0%）因扩张型心肌病导致的心力衰竭接受地高辛治疗，4例（22.2%）因室间隔缺损，3例（16.7%）因室上性心动过速，2例（11.1%）因心脏手术后接受地高辛治疗。所采集的20对样本中，唾液中的地高辛浓度为0.0至0.92 ng/mL（平均[标准差]，0.25[0.26] ng/mL），血浆中的地高辛浓度为0.27至1.54 ng/mL（平均[标准差]，0.77[0.40] ng/mL）。血浆/唾液地高辛浓度的平均比值为2.8。
本研究纳入了因各种适应证接受地高辛治疗且剂量维持≥10天不变的婴幼儿、儿童及青少年，结果显示唾液/血浆浓度比值存在显著个体差异，因此无法用唾液来预测血浆地高辛浓度。唾液地高辛（与血浆地高辛相对）测定在评估儿童药物心脏效应中的价值仍有待确定。
