Pichini S, Altieri I, Zuccaro P, Pacifici R
Clinical Biochemistry Unit, Istituto Superiore di Sanità, Rome, Italy.
Clin Pharmacokinet. 1996 Mar;30(3):211-28. doi: 10.2165/00003088-199630030-00003.
Determination of the concentration of drugs and metabolites in biological fluids or matrices other than blood or urine (most commonly used in laboratory testing) may be of interest in certain areas of drug concentration monitoring. Saliva is the only fluid which can be used successfully as a substitute for blood in therapeutic drug monitoring, while an individual's past history of medication, compliance and drug abuse, can be obtained from drug analysis of the hair or nails. Drug concentrations in the bile and faeces can account for excretion of drugs and metabolites other than by the renal route. Furthermore, it is important that certain matrices (tears, nails, cerebrospinal fluid, bronchial secretions, peritoneal fluid and interstitial fluid) are analysed, as these may reveal the presence of a drug at the site of action; others (fetal blood, amniotic fluid and breast milk) are useful for determining fetal and perinatal exposure to drugs. Finally, drug monitoring in fluids such as cervical mucus and seminal fluid can be associated with morpho-physiological modifications and genotoxic effects. Drug concentration measurement in nonconventional matrices and fluids, although sometimes expensive and difficult to carry out, should therefore be considered for inclusion in studies of the pharmacokinetics and pharmacodynamics of new drugs.
在药物浓度监测的某些领域，测定生物体液或除血液或尿液之外的基质（实验室检测中最常用的是血液和尿液）中的药物和代谢物浓度可能具有重要意义。唾液是唯一能在治疗药物监测中成功替代血液的体液，而通过对头发或指甲进行药物分析，可以了解个人过去的用药史、服药依从性及药物滥用情况。胆汁和粪便中的药物浓度可反映除肾脏排泄途径之外的药物和代谢物的排泄情况。此外，分析某些基质（眼泪、指甲、脑脊液、支气管分泌物、腹膜液和组织液）很重要，因为这些可能揭示药物在作用部位的存在情况；其他一些基质（胎儿血液、羊水和母乳）对于确定胎儿和围产期药物暴露情况很有用。最后，对宫颈黏液和精液等体液进行药物监测可能与形态生理改变和遗传毒性作用有关。因此，尽管在非常规基质和体液中进行药物浓度测定有时成本高昂且操作困难，但在新药的药代动力学和药效学研究中应考虑纳入此类测定。
