他克莫司治疗肾小球疾病的血药浓度监测及疗效影响因素分析  

Blood Concentration Monitoring and Predictors of Response in Patients with Glomerulonephritis Treated with Tacrolimus

作　　者：钱卿[1] 韩睿[1] 胡楠[1] 邹素兰[1] 王莉英[1] QIAN Qing HAN Rui HU Nan ZOU Su-lan WANG Li-ying(Department of Pharmacy, the First People＇s Hospital of Changzhou, Changzhou 213003, China)

机构地区：[1]常州市第一人民医院药剂科,常州213003

出　　处：《药学与临床研究》2017年第5期435-438,共4页Pharmaceutical and Clinical Research

基　　金：常州市科技局医院药学科研项目(2016406)

摘　　要：探讨肾小球疾病患者治疗药物他克莫司的监测情况以及血药浓度等因素对临床疗效的影响。采用回顾性分析方法,统计我院2014年1月至2016年12月期间服用他克莫司治疗肾小球疾病的患者的血药浓度监测结果,并观察评估其临床疗效及不良反应。103例患者监测他克莫司血药谷浓度共计935例次,50.7%的浓度值位于目标范围内。疗效评价结果显示,12个月时的完全缓解率为55.4%,部分缓解率为32.3%,复发率为24.6%。治疗前基线血清肌酐值、12个月内他克莫司平均血药浓度对总体缓解率的影响有显著性意义。膜性肾病患者的基线尿蛋白水平、12个月内他克莫司平均血药浓度对完全缓解率的影响存在显著性意义。肾小球疾病患者他克莫司血药谷浓度达标率较低,且血药浓度对疗效的影响有显著性意义,故有必要进行规律的治疗药物监测。This article is to discuss the results of therapeutic drug monitoring and the factors that influence response after tacrolimus therapy in patients with glomerulonephritis. In this retrospective study, a total of 103 patients with glomerulonephritis treated with tacrolimus were included from 2014 to 2016. The blood concentration results, effectiveness and safety of tacrolimus treatment were investigated. For the blood concentrations, 50.7% of the 935 tests were in the target range. Among the 65 patients who received therapy more than one year and had regular follow-up, 55.4% achieved complete remission（CR） and32.3% partial remission（PR） after 12 months of treatment. Almost a quarter（24.6%） of the responders relapsed. Serum creatinine at baseline and mean blood tacrolimus levels within 12 months were factors significantly associated with total remission. For IMN patients, lower baseline proteinuria and higher mean blood tacrolimus level predicted occurrence of CR. For patients with glomerulonephritis, the rate of trough concentration in target range was low and the blood exposure had significance influence on clinical remission. Therefore it is of great importance to monitor the blood level of tacrolimus.

关 键 词：他克莫司 治疗药物监测 肾小球肾炎 

分 类 号：R969.1[医药卫生—药理学] R969.3[医药卫生—药学]