器官移植预后预测新指标:患者他克莫司浓度个体内的变异性  

Intra-patient variability of tacrolimus concentration in transplant recipients: a prognostic predictor post transplantation

作　　者：李玲[1] 李宁[1] 艾紫叶 姚亚君 魏婉慧 何维阳 王彦峰[1] 叶啟发[1,2] 

机构地区：[1]武汉大学中南医院武汉大学肝胆疾病研究院武汉大学移植医学中心移植医学技术湖北省重点实验室,湖北省武汉市430071 [2]中南大学湘雅三医院卫生部移植医学工程技术研究中心,湖南省长沙市410013

出　　处：《中国组织工程研究》2016年第49期7437-7442,共6页Chinese Journal of Tissue Engineering Research

基　　金：湖北省自然科学基金创新群体(2015CFA018)~~

摘　　要：背景:他克莫司是一种钙调神经磷酸酶抑制剂,广泛应用于预防器官移植后的移植物排异反应及多种免疫性疾病。但如何找到他克莫司浓度有效性和安全性之间的理想平衡点是目前困扰移植医生的一大难题。目的:综述影响他克莫司浓度个体内变异性的因素,探讨该个体内变异性与移植预后相关性,为将他克莫司浓度个体内变异性监测应用于临床,优化移植长期效果提供依据。方法:用计算机检索中国期刊全文数据库、PubM ed、SpringerL ink、Elsevier Science Direct数据库,检索时间1996年1月至2016年6月,检索词分别为"他克莫司,个体内变异性,器官移植;预后"和"Tacrolimus,intra-patient variability,organ transplantation,outcomes"。对筛选出的38篇相关文献进行分析讨论。结果与结论:他克莫司浓度有效性和安全性传统仅用谷浓度来调整给药剂量,进行个体化给药,临床治疗效果并不理想。诸多因素可影响他克莫司药代动力学参数及他克莫司浓度个体内变异性。大量研究报道,他克莫司浓度个体内变异性是肾移植远期预后的预测因子。检测到患者他克莫司药物浓度波动较大,应该尝试教育患者注意食物和非处方药物对他克莫司浓度的影响。BACKGROUND： Tacrolimus, a kind of calcineurin inhibitor, is widely applied in the prophylaxis of graft rejection after transplantation and various immune diseases. However, how to find an ideal balance between efficacy and safety of tacrolimus remains a difficulty. OBJECTIVE： To summarize the main determining factors affecting intra-patient variability of tacrolimus concentration and its association with transplant prognosis, thereby providing evidence for the application of intra-patient variability of tacrolimus concentration and the optimization for long-term transplant outcomes. METHODS： A computer-based search in databases of CNKI, Pub Med, SpringerL ink and Elsevier Science Direct in January 1996 and June 2016 using the keywords of ＂tacrolimus, intra-patient variability, organ transplantation, outcomes＂ in English and Chinese, respectively. Finally 38 eligible articles were selected for analysis. RESULTS AND CONCLUSION： Tacrolimus is often tested by therapeutic drug monitoring in clinic. Individualized administration of drugs by traditional valley point concentrations has not achieved an ideal therapeutic efficacy yet. Various factors influence pharmacokinetic parameters of tacrolimus and the concentration variability in vivo. Considerable researches show that the variability of tacrolimus concentration in kidney transplant recipients is a post-transplantation predictor. Tacrolimus concentration is shown to change markedly in patients, so patients should take food and nonprescription drugs prudently.

关 键 词：他克莫司 肾移植 器官移植 组织工程 组织构建 移植 个体内变异性 预后 湖北省自然科学基金 

分 类 号：R318[医药卫生—生物医学工程]