PROTEIN-BINDING OF ANTIEPILEPTIC DRUGS DURING PREGNANCY, LABOR, AND PUERPERIUM
PROTEIN-BINDING OF ANTIEPILEPTIC DRUGS DURING PREGNANCY, LABOR, AND PUERPERIUM
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DOI：
10.1097/00007691-199001000-00008
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发表时间：
1990-01-01
影响因子：
2.5
通讯作者：
NEUVONEN, PJ
中科院分区：
文献类型：
--
作者：
BARDY, AH;HIILESMAA, VK;NEUVONEN, PJ
24例癫痫妇女在妊娠晚期、分娩期和产褥期早期进行随访，以检测抗癫痫药物（AED）血清蛋白结合的可能改变。测定母体血清中卡马西平（CBZ）、苯妥英（PHT）和丙戊酸盐（VPA）的总浓度和游离浓度。此外，还测量了白蛋白、α 1-酸性糖蛋白（AGP）和游离脂肪酸（FFA）的浓度。总AED浓度在分娩过程中的药物剂量的变化的影响：总PHT增加在产后第一周。在分娩过程中，CBZ的游离分数保持稳定，而PHT，特别是VPA游离分数增加。这种现象是平行的FFA浓度的增加，FFA浓度再次下降，在产后的第一天。白蛋白和AGP浓度在妊娠和分娩期间较低，分娩后升高。总脐带CBZ和PHT浓度与母体浓度无显著差异。分娩时脐血VPA总量低于母血。脐带血中白蛋白含量高于母血，而AGP和FFA含量低于母血。当评估母体和脐带血中这些药物的总浓度时，应考虑PHT的变化，尤其是与FFA浓度变化相关的VPA游离分数的变化。
Twenty-four epileptic women were followed-up during late pregnancy, labor, and early puerperium in order to detect possible alterations in serum protein binding of antiepileptic drugs (AEDs). The total and free concentrations of carbamazepine (CBZ), phenytoin (PHT), and valproate (VPA) in maternal serum were measured. In addition, the concentrations of albumin, .alpha.1-acid glycoprotein (AGP), and free fatty acids (FFA) were also measured. Total AED concentrations during labor were influenced by changes in drug dosages: total PHT increased during the first puerperal weeks. During labor the free fraction of CBZ remained stable, whereas PHT and particularly VPA free fractions increased. This phenomenon was parallel to the increase in FFA concentration; FFA concentrations decreased again during the first days post-partum. Albumin and AGP concentrations were low during pregnancy and labor, and increased after delivery. The total umbilical CBZ and PHT concentrations were not significantly different from maternal concentrations. The total VPA lower in umbilical than in maternal serum at delivery. Umbilical cord serum had a higher albumin but a lower AGP and FFA concentration than maternal serum. The changes in PHT and particularly VPA free fraction associated with changes in FFA concentration should be considered when assessing the total concentration of these drugs in maternal and umbilical serum.