Hazane C, Jalabert M, Saubion J L
Med Trop (Mars). 1985 Apr-Jun;45(2):145-53.
The progress of a drug through human body depends not only on the inherent factors of the drug and on its formulation but also on individual physio pathological variations such as nutritional status. Pharmacokinetics of drug depend on 4 main stages (absorption, distribution, metabolisation and excretion) as showed by the serum concentrations curve or by renal elimination function of the time. Thanks to these curves one can deduce parameters currently in use. The mechanism of each of these stages is discussed and their modifications are studied in Protein Energy Malnutrition (P.E.M.). In the P.E.M. (especially in the case of child kwashiorkor) these pharmacokinetic parameters can be modified following perturbations in hydro-mineral balance, gastro-intestinal renal, hepatic functions, but principally following perturbations of the plasmatic proteins. Some of these diminish (R.B.P., albumin, prealbumin) and others increase (alpha glycoprotein acid, C reactive protein, haptoglobin, gamma globulins). Generally speaking the binding between a drug and plasmatic proteins is lowered increasing the non-bound drug quantity, the latter is more easily eliminated thus lowering the half-life of the drug provided the hepatic and renal functions are not too seriously damaged. Clinical consequences are discussed.
药物在人体中的进程不仅取决于药物的内在因素及其剂型，还取决于个体的生理病理变化，如营养状况。药物的药代动力学取决于4个主要阶段（吸收、分布、代谢和排泄），血清浓度曲线或肾脏排泄功能随时间的变化显示了这些阶段。借助这些曲线，可以推导出目前使用的参数。本文讨论了这些阶段中每个阶段的机制，并研究了蛋白质能量营养不良（P.E.M.）情况下它们的变化。在P.E.M.（尤其是儿童夸希奥科病的情况下），这些药代动力学参数可因水盐平衡、胃肠肾、肝功能的紊乱而改变，但主要是因血浆蛋白的紊乱而改变。其中一些减少（视黄醇结合蛋白、白蛋白、前白蛋白），另一些增加（α-糖蛋白酸、C反应蛋白、触珠蛋白、γ-球蛋白）。一般来说，药物与血浆蛋白之间的结合降低，非结合药物量增加，后者更容易被清除，因此在肝肾功能未受到太严重损害的情况下，药物的半衰期会缩短。本文还讨论了临床后果。
