Perry P J, Zeilmann C, Arndt S
Department of Psychiatry, College of Medicine, University of Iowa, Iowa City 52246.
J Clin Psychopharmacol. 1994 Aug;14(4):230-40.
An analysis of the literature on tricyclic antidepressant level in blood using receiver operating characteristics curves as the primary statistical tool was performed. For nortriptyline, a significant curvilinear relationship between therapeutic response and nortriptyline was observed that ranged from 58 to 148 ng/ml. The sensitivity and specificity for the nortriptyline therapeutic window were 78 and 61%, respectively. The response rate within the therapeutic range was 66% versus 26% outside the therapeutic range. For desipramine, a significant linear relationship between therapeutic response and desipramine concentration in plasma was observed. The threshold concentration in plasma for therapeutic response was 116 ng/ml. The sensitivity and specificity for the desipramine threshold level in blood were 81 and 59%, respectively. The response rate above the threshold level was 51% versus 15% below the therapeutic threshold concentration. For imipramine, a significant curvilinear relationship between therapeutic response and total imipramine (imipramine+desipramine) concentration in plasma was observed between 175 and 350 ng/ml. The sensitivity and specificity for the total imipramine concentrations in plasma were 52 and 74%, respectively. The response rate within the therapeutic range was 67% versus 39% outside the therapeutic range. For amitriptyline, a significant curvilinear relationship between therapeutic response and total amitriptyline (amitriptyline+nortriptyline) concentration in plasma was observed between 93 and 140 ng/ml. The sensitivity and specificity for the total imipramine concentrations in plasma were 37 and 80%, respectively. The response rate within the therapeutic range was 50% versus 30% outside the therapeutic range.
采用受试者工作特征曲线作为主要统计工具，对有关血液中三环类抗抑郁药水平的文献进行了分析。对于去甲替林，观察到治疗反应与去甲替林之间存在显著的曲线关系，范围为58至148纳克/毫升。去甲替林治疗窗的敏感性和特异性分别为78%和61%。治疗范围内的反应率为66%，而治疗范围外为26%。对于地昔帕明，观察到治疗反应与血浆中地昔帕明浓度之间存在显著的线性关系。治疗反应的血浆阈值浓度为116纳克/毫升。血液中地昔帕明阈值水平的敏感性和特异性分别为81%和59%。阈值水平以上的反应率为51%，而治疗阈值浓度以下为15%。对于丙咪嗪，观察到治疗反应与血浆中总丙咪嗪（丙咪嗪+地昔帕明）浓度在175至350纳克/毫升之间存在显著的曲线关系。血浆中总丙咪嗪浓度的敏感性和特异性分别为52%和74%。治疗范围内的反应率为67%，而治疗范围外为39%。对于阿米替林，观察到治疗反应与血浆中总阿米替林（阿米替林+去甲替林）浓度在93至140纳克/毫升之间存在显著的曲线关系。血浆中总丙咪嗪浓度的敏感性和特异性分别为37%和80%。治疗范围内的反应率为50%，而治疗范围外为30%。
