肾移植供肾MDR1基因多态性对FK506肾毒性和血药浓度的影响  

作　　者：叶青[1] 傅尚希[1] 王纪渊 王立明[1] 

机构地区：[1]第二军医大学附属长征医院器官移植科,200003

出　　处：《浙江临床医学》2014年第12期1883-1884,1889,共3页Zhejiang Clinical Medical Journal

摘　　要：目的：观察肾移植术后供肾多药耐药基因（MDR1）外显子26及外显子21的基因型对他克莫司（FK506）急慢性肾毒性和血药浓度的影响。方法回顾51例肾移植术后常规使用FK506＋MMF＋Pred三联免疫抑制用药方案的患者资料。通过基因组测序检测肾移植供者MDR1 exon26和exon21的基因型，比较不同供肾基因型的患者FK506的用量、血药浓度及和肾毒性的差异。结果在术后1年时比较内生肌酐清除率时，在exon26中，TT型的内生肌酐清楚率明显低于CC型和CT型（P＜0.05），在exon21中，低表达型（TT型）明显低于高表达型（GG/GT/GA/AT型）（P＜0.05）；在比较术后1个月内的移植肾急性肾中毒发生率时，exon21中低表达型明显高于高表达型（P＜0.05）。结论在保护移植肾功能，减少FK506的急慢性肾毒性上，exon26的CC/CT型和exon21的高表达型明显优于exon26的的TT型和低表达型。ObjectiveTo explore the significance of kidney MDRl gene polymorphism for taking FK506 in renal transplant recipients. To guide clinicians adjust the tacrolimus dosage in the clinical to reduce the side effects of tacrolimus.MethodsSelect clinical date of 50 patients receiving renal transplantation the first time in our hospital from July 2012 to February 2013 period .Taking FK506＋MMF＋ Pred triple immunosuppressive regimen after operation and determine their MDR1 genotype. According to clinical date,compare the difference of donor kidney MDR1 exon21 and exon26 on patients with different genotypes the daily dose of FK506 and acute/chronic toxicity to the transplant kidney.ResultsComparing recipients’ Ccr one year after renal transplantation,in MDR1 exon26,TT-type Ccr was significantly lower than CC-type and CT-type（P〈0.05）,the difference between CC-and CT-type has no statistical significance. In exon21,the Ccr of low expression type（TT type）was significantly lower than the high expression of type （GG/GT/GA/AT-type）Comparing the incidence of acute renal toxicity induced by FK506 in one month after surgery,in MDR1 exon21,the low expression type（TT type）is greater than the expression of type（GG/GT/GA/AT-type）（P〈0.05）. There is no significant difference（P〉 0.05）between MDR1 exon26 genotypes.ConclusionIn the protection of graft function,reduction of acute and chronic renal toxicity of FK506,in MDR1 exon26,the CC / CT type is significantly better than TT type. And in MDR1 exon21,the high-expressed type is significantly better than low-expression type.

关 键 词：肾移植 他克莫司 多药耐药基因 肾毒性 

分 类 号：R699.2[医药卫生—泌尿科学]