他克莫司在成人与儿童尸体及活体肝移植受体间的代谢差异  

Metabolic differences of tacrolimus between LDLT and DDLT of adult and pediatric liver transplant recipients

作　　者：严莲珍[1] 陈丽[2] 王鲁君[1] 鲁燕侠[1,3] 

机构地区：[1]武警总医院药剂科,北京100039 [2]武警总医院计算机管理中心,北京100039 [3]北京大学医学部药学院,北京100191

出　　处：《武警后勤学院学报（医学版）》2014年第7期578-582,共5页Journal of Logistics University of PAP（Medical Sciences）

摘　　要：【目的】考察术后早期成人与儿童肝移植受体间的代谢差异，为临床合理使用免疫抑制剂提供参考。【方法】回顾性选取2007年5月-2013年2月在武警总医院器官移植中心接受尸体及活体肝移植术的成年及儿童肝移植受体40例，分为4组，分别考察各组术后早期他克莫司的剂量、血药浓度差异及其对于不同肝移植受体肝。肾功能、血液系统的影响。【结果】儿童活体肝移植他克莫司的剂量0．23mg·（kg·d）。与谷浓度7．63旧L均较尸体肝移植相应值[0．17mg·（kg·d）。与7．01μg/L】略高，但均无统计学差异；成人尸体肝移植他克莫司的剂量0．08mg·（kg·d）。略高于活体肝移植0．07mg·（kg·d）-1，而对应的谷浓度值（7．42μg/L与9.71μg/L）却恰好相反，前者无统计学差异，后者具有显著差异；儿童尸体肝移植剂量0．17mg·（kg·d）-1是成人尸体肝移植剂量0．08mg·（kg·d）-1的2．15倍，儿童活体肝移植剂量0．23mg·（kg·d）-1是成人活体肝移植剂量0．07mg·（kg·d）-1的3．42倍，组间比较均具有显著差异（P〈0．05），而其相应谷浓度7．63雌几与9．71州L组间比较无显著差异；术后早期不同肝移植受体谷浓度均值为7．9μg/L，均未达到文献上10～15μg/L的目标值；生化参数除ALB、UA、PLT外，基本未达标。【结论】成人肝移植受体，要达到相同的谷浓度，活体肝移植与尸体肝移植比较，需要较小的他克莫司剂量；儿童要达到与成人相同的谷浓度，剂量是成人的2～4倍；术后早期他克莫司在不同肝移植受体间的代谢差异显著，需要个体化用药。[ Objective ] To investigate the metabolic differences of tacrolimus between adult and pediatric liver transplant recipients in order to provide reference for rational clinical use of immunosuppressive agents. [Methods] 40 adult and pediatric liver transplant recipients who received dead donor or living donor transplantation in the organ transplant center of General Hospital of Armed Police Forces from May 2007 and February 2013 were retrospectively selected. All the patients were divided into four groups. For each group, the differences between tacrolimus dose, plasma concentration, and their impact on the function of liver and kidney as well as on blood system were investigated during the early postoperative periods. [ Results] For pediatrics the ratio of tacrolimus dose and its through concentration of the living donor liver transplant recipients was slightly higher than the dead donor liver transplant nnes, but there existed no statistically significant difference between them; For adults, tacrolimus dose of the dead donor liver transplant recipients was slightly higher than the living donor liver transplant ones, but there existed no significant differences between them, but through concentrations C was just opposite and there were significant differences between the two. For dead donor liver transplant recipients, the dose of pediatrics was 2.15 times of the adults, while for living donor liver transplant recipients, the dose of children was 3.42 times of the adults and there existed significant differences （P 〈0.05） between the groups whereas no significant differences existed about their corresponding trough concentration; during the first month of the operation, the mean trough concentration of the liver transplant recipients was 7.9 and did not reach the target value 10-15 ~g/ml; The indexes of the biochemical parameters were all abnormal except ALB, UA, PLT. [Conclusions]To achieve the same tacrolimus trough concentration, the adult living donor liver transplant recipients required smaller doses

关 键 词：他克莫司 肝移植受体 代谢差异 

分 类 号：R965[医药卫生—药理学]