High serum concentrations of the acyclovir main metabolite 9-carboxymethoxymethylguanine in renal failure patients with acyclovir-related neuropsychiatric side effects:: an observational study
High serum concentrations of the acyclovir main metabolite 9-carboxymethoxymethylguanine in renal failure patients with acyclovir-related neuropsychiatric side effects:: an observational study
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DOI：
10.1093/ndt/gfg119
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发表时间：
2003-06-01
影响因子：
6.1
通讯作者：
Ståhle, L
中科院分区：
文献类型：
--
作者：
Helldén, A;Odar-Cederlöf, I;Ståhle, L
背景阿昔洛韦（ACV）已被用于治疗疱疹病毒感染超过二十年。肾功能衰竭患者在无环鸟苷治疗期间发生了严重的神经系统不良反应，但症状的原因仍不清楚。我们推测ACV主要代谢物9-羧甲氧基甲基鸟嘌呤（CMMG）浓度的增加与这些代谢物相关。我们从1991年至1999年中期进行了一项观察性研究，该研究基于从瑞典各医院部门发送的用于分析ACV浓度的样本。将有神经精神症状的患者（NS+，n=49）与无症状的患者（NS-，n=44）进行比较。通过HPLC分析ACV和CMMG浓度。分析病历中的症状，并与Medline.Results. NS+组血清CMMG水平（平均值=34.1 mumol/l，95%可信区间23.4-46.1）显著高于NS-组（平均值= 4.7 mumol/l，95%可信区间3.3-6.6; P
Background. Acyclovir (ACV) has been used for over two decades to treat herpes virus infections. Serious neurological adverse side effects have occurred during ACV treatment in patients with renal failure, but the cause of the symptoms remains unknown. We hypothesized that increased concentrations of the ACV main metabolite 9-carboxymethoxymethylguanine (CMMG) correlated to these symptoms.Methods. We conducted an observational study from 1991 to mid 1999 based on samples sent for analysis of ACV concentration from various hospital departments in Sweden. Patients with neuropsychiatric symptoms (NS+, n=49) were compared with patients without symptoms (NS-, n=44). ACV and CMMG concentrations were analysed by HPLC. Medical records were analysed for symptoms and compared with pertinent cases identified from Medline.Results. The serum CMMG levels were significantly higher in the NS+ group (mean=34.1 mumol/l, 95% confidence interval 23.4-46.1) compared with the NS- group (mean = 4.7 mumol/l, 95% confidence interval 3.3-6.6; P