活体部分肝移植与尸体全肝移植的他克莫司应用及用药规律分析  

Monitoring and regularity of tacrolimus in patients subject to cadaveric liver transplantation and livingdonor partial liver transplantation

作　　者：李月霞[1] 张禹[2] 付鹏[1] 张弋[1] 

机构地区：[1]300192天津市第一中心医院药剂科 [2]天津医科大学

出　　处：《中华器官移植杂志》2014年第1期37-40,共4页Chinese Journal of Organ Transplantation

基　　金：天津市卫生局科技基金重点（07KY27）;天津市卫生局攻关课题（1IKG102）

摘　　要：目的分析比较活体部分肝移植和尸体全肝移植受者他克莫司的应用及用药规律。方法回顾性分析2（）10年1月至2011年10月应用他克莫司的肝移植受者68例临床资料。其中，进行活体部分肝移植的受者31例，进行尸体全肝移植的受者37例。结果移植后，在使用相同的他克莫司初始剂量下，活体部分肝移植组达到治疗窗的时间为（3．9±0．7）d，明显少于尸体全肝移植组的（6．5±1．0）d，差异有统计学意义（P〈0．01）。活体部分肝移植组他克莫司的用量在术后28d内明显低于尸体全肝移植组，但随着时间的延长两者差距逐渐接近。术后7、14、21和28d时活体部分肝移植组的用药量分别为尸体全肝移植组的72．37％、79．31％、90．11％和95．45％。尸体全肝移植组的他克莫司浓度／（他克莫司剂量／受者体质量）[C／（D／W）]处于较稳定状态，维持在80-90，活体部分肝移植组的C／（D／W）随时间逐渐降低，最终在28d左右与尸体全肝移植组接近。在相关性分析中，活体部分肝移植组移植物受者质量比（GRWR）与其术后第7天他克莫司剂量／受者体质量呈显著正相关（r=0．591，P〈0．01）；与C／（D／W）呈显著负相关（r=-0．586，P〈0．01）。结论活体部分肝移植受者术后早期他克莫司用量与GRWR显著相关；成人活体部分肝移植的早期用量约相当于尸体全肝移植者的70％。随着活体部分肝移植肝脏的不断再生，至术后28d时他克莫司的用量可基本接近尸体全肝移植者水平。Objective To analyze and compare the therapeutic drug monitoring （TDM） and regularity of tacrolimus in deceased donor liver transplantation （DDLT） and living-donor partial liver transplantation （LDLT） the therapeutic drug monitoring （TDM） and regularity of tacrolimus. Method The clinical data of 68 patients undergoing liver transplantation from January 2010 to October 2011 were analyzed retrospectively. Thirty cases underwent LDLT as group A, and the remaining 37 underwent DDLT as group B. Result The time to reach therapeutic window was shorter in group A （3.9 ± 0. 7 days） than in group B （6. 5 ±1.0 days, P〈0. 01）. The tacrolimus dosage in group A was significantly less than that in group B during the first 28 days post-transplantation. However, the tacrolimus dosage approached gradually and tended to be consistent after 28 days. On the postoperative day 7, 14, 21 and 28, the Tacrolimus dosage in group A was 72. 37%, 79. 31%, 90. 11% and 95.45% of that in group B respectively. Concentration-dose ratio in group B was in a steady state （80-90 g/L）. Concentration-dose ratio in group A was decreased with time, culminating at 28th day and close to that in group B. Correlation analysis revealed that graft recipient weight ratio （GRWR） had a significantly positive correlation with the tacrolimus dosage on the first 7 days （r = 0. 557） and a significantly negative correlation with the tacrolimus concentration/dose ratio （r = -0. 578）. Conclusion The early tacrolimus dosages in patients subject to LDLT were correlated significantly with the GRWR. The early tacrolimus dosages in patients undergoing LDLT were about 70% of those in patients undergoing LDLT. However, with the regeneration of the liver, they tended to be consistent after 28 days.

关 键 词：活体供者 肝移植 他克莫司 血药浓度 

分 类 号：R657.3[医药卫生—外科学]