Jenne J W
J Allergy Clin Immunol. 1986 Oct;78(4 Pt 2):727-35. doi: 10.1016/0091-6749(86)90053-9.
Host factors play an important role in the dosing requirements of theophylline. Theophylline metabolism and clearance depend principally on liver cell function rather than on hepatic flow. The effects of acute hypoxemia require more study; however, patients with chronic obstructive pulmonary disease who have chronic hypoxemia appear to have some impairment of clearance. Clearance is variably and sometimes drastically reduced in patients with liver disease and heart failure, and is reduced by some viral infections. It is not impaired by renal failure. Current split-virus vaccine mixtures do not appear to affect clearance. Clearance is increased in patients with cystic fibrosis and hyperthyroidism. The depressed clearance seen in the severely ill patients who require intensive care improves with improvement in the patient's condition, but the individual factors involved have not been identified. An area requiring more study is the effect of pH on the apparent distribution volume for theophylline. In the presence of liver disease, heart failure, or serious illness, caution must be applied in theophylline dosing, with frequent monitoring of serum levels. Stable patients also warrant an initially conservative dose until serum levels are obtained to guide further dose adjustments.
宿主因素在茶碱的给药剂量需求中起着重要作用。茶碱的代谢和清除主要取决于肝细胞功能而非肝血流量。急性低氧血症的影响需要更多研究；然而，患有慢性低氧血症的慢性阻塞性肺疾病患者似乎存在一定程度的清除功能受损。在肝病和心力衰竭患者中，清除率会有不同程度降低，有时甚至大幅降低，一些病毒感染也会使其降低。肾衰竭不会损害清除率。目前的裂解病毒疫苗混合物似乎不影响清除率。囊性纤维化和甲状腺功能亢进患者的清除率会升高。在需要重症监护的重症患者中观察到的清除率降低情况会随着患者病情改善而改善，但其中涉及的个体因素尚未明确。一个需要更多研究的领域是pH值对茶碱表观分布容积的影响。在存在肝病、心力衰竭或严重疾病的情况下，茶碱给药时必须谨慎，并频繁监测血清水平。病情稳定的患者在获得血清水平以指导进一步剂量调整之前，初始剂量也应保守。
