移植后高血压与他克莫司剂量及血药浓度的关系  

Relationship between post-transplantation hypertension and dose,plasma concentration of tacrolimus

作　　者：席兰艳[1,2] 袁洪[1] 成柯[3] 朱利军[3] 阳国平[1] 张桂香[1] 黄志军[1] 

机构地区：[1]中南大学湘雅三医院临床药理中心 [2]长沙市中心医院药学部 [3]中南大学湘雅三医院器官移植中心

出　　处：《中国临床药理学与治疗学》2012年第1期78-82,共5页Chinese Journal of Clinical Pharmacology and Therapeutics

基　　金：国家重点基础研究发展计划(2011CB512001);湖南省国际合作科技计划重点项目(2010WK2006)

摘　　要：目的:调查肾移植患者服用他克莫司后高血压的发生率,并探讨移植后高血压与他克莫司的服用剂量、血药浓度及血药浓度/剂量的相关性。方法:选取以他克莫司进行治疗的肾移植患者200例,测量患者的血压。然后从中随机抽取53例高血压患者和53例正常血压患者,待患者服用他克莫司至少3d后,运用微粒子酶免疫分析(MEIA)法测定他克莫司谷浓度,分析他克莫司剂量、血药浓度与血压水平的相关性,并比较两组患者的他克莫司剂量、血药浓度及血药浓度/剂量的差异。结果:在200例肾移植患者中,104例患者(52.0%)患有移植后高血压;他克莫司日剂量与患者的SBP呈正相关(r=0.216,P<0.05),而剂量与DBP,血药浓度与血压水平均无相关性;高血压组他克莫司的服用剂量明显高于正常血压组[(3.11±1.49)mg/d∶(2.42±1.07)mg/d,P<0.05];谷浓度两组间比较差异无统计学意义(P>0.05);高血压组患者的谷浓度/剂量明显低于正常血压组[(2.94±1.57)ng.d/mg.mL∶(3.95±3.02)ng.d/mg.mL,P<0.05]。结论:肾移植患者的SBP与他克莫司日剂量具有明显相关性,服用更高剂量他克莫司的患者更易发生高血压。ABSTRACT AIM： To investigate the incidence of hypertension after renal transplantation in patients administered with taerolimus, and the correlation among blood pressure, tacrolimus dos- age, plasma concentration and concentration/ dose ratio of tacrolimus. METHODS： 200 renal transplant patients treated with tacrolimus were screened in the study, and the blood pressure were measured. Fifty-three hypertensive patients and Fifty-three normotensive patients were ran- domly enrolled from all screened patients. Ta- crolimus was administrated at a stable dose for at least 3 days. Tacrolimus trough level was de- termined by Microparticle Enzyme Immunoassay （MEIA）. The association of blood pressure in tacrolimus dosage and concentration were ana- lyzed. Meanwhile, the dosage, plasmid level and concentration/dose ratio of tacrolimus were com- pared in the normotensive and hypertensive group. RESULTS： Hypertension was present in 104 post-transplantation patients out of 200 pa- tients （52.0%）. Spearman＇s correlation analysis revealed a positive correlation existed between systolic blood pressure （SBP） and the dose of ta-crolimus （r=0.216, P〈0.05）. However, there was no significant correlation between diastolic blood pressure and tacrolimus trough lev el. The oral dosage of tacrolimus in hypertension group （3.11±1.49） mg/d was higher than that in normotensive group （2.42±1.07） mg/d （P%0.05）. There was no significant difference in tacrolimus trough level between the two groups FHBP vs Nor. （7.76±3.86） ng/mL vs （7.56±2.67） ng/mL, P〉0.05]. The concentration/ dose ratio of tacrolimus was lower in hypertension group than that in normotensive group [（2.94 ± 1.57） ng· d/mg· mL vs （3.95 ± 3.02） ng· d/mg. mL, P〈0.05）. CONCLU- SION： The present study demonstrated that SBP of renal transplant patients was positively correlated with tacrolimus daily dosage. Administra- tion of tacrolimus with higher dosage may in crease the predisposition to hypertension.

关 键 词：肾移植 高血压 他克莫司 剂量 血药浓度 

分 类 号：R544.14[医药卫生—心血管疾病]