180例肾移植患者他克莫司血药浓度监测  

Blood Concentration Monitoring of Tacrolimus in 180 Renal Transplant Recipients

作　　者：胡楠[1] 赵金飞 蒋艳[1] 韩睿[1] 严佳瑾 邹素兰[1] Nan HU;Jinfei ZHAO;Yan JIANG;Rui HAN;Jiajin YAN;Sulan ZOU(Department of Pharmacy,the First People＇s Hospital of Changzhou,the Third Affiliated Hospital of Soochow University,Changzhou 213003,China;School of Pharmacy,Xuzhou Medical University,Xuzhou 221004,China)

机构地区：[1]常州市第一人民医院苏州大学附属第三医院药剂科,常州213003 [2]徐州医科大学药学院,徐州221004

出　　处：《医药导报》2018年第12期1500-1505,共6页Herald of Medicine

基　　金：国家自然科学基金(81503136);常州市医院药学科研专项指导性项目(2016406);常州市卫生人才培养工程项目(2016CZBJ010)

摘　　要：目的研究肾移植患者术后不同时间段他克莫司(FK506)血药浓度的监测情况,为临床安全合理使用FK506提供参考。方法以180例肾移植患者为研究对象,分析术后时间、用药剂量、患者性别、年龄及CYP3A5基因多态性等因素与FK506血药浓度的关系。结果肾移植患者手术1个月后,FK506的用药剂量、血药浓度随着术后时间的延长而逐渐降低,血药浓度的个体差异较大;在术后0～7 d,女性患者血药浓度高于男性(P<0.05),其他时间段内,性别对患者用药剂量、血药浓度的影响差异无统计学意义;在术后的同一时间段中,高龄组(年龄>45岁)患者的用药剂量均略低于低龄组(年龄16～45岁),其中3～6个月内差异有统计学意义(P<0.05)。CYP3A5*3基因多态性对肾移植患者FK506血药浓度影响较大,在术后的同一时间段中,CYP3A5*1*1型患者FK506用药剂量显著高于CYP3A5*1*3型和CYP3A5*3*3型患者(P<0.05),而CYP3A5*1*1型患者血药浓度显著低于CYP3A5*1*3型和CYP3A5*3*3型患者(P<0.05)。结论 FK506血药浓度监测和基因多态性检测可降低免疫过度、不足和药物不良反应的发生,有利于提高移植肾的长期存活率。Objective To study the monitoring of tacrolimus （FK506） blood concentration at different time points after renal transplantation, and provide reference for safe and rational use of FK506 in clinic. Methods In total, 180 renal transplant recipients were included and analyzed in this study.The relationship between FK506 blood concentration and time after operation, dose, sex, age and CYP3A5 polymorphism was analyzed. Results At the time of one month after renal transplantation, FK506 dosage and blood concentration of patients decreased gradually with great individual differences.At the time of 0-7 days after transplantation, the FK506 blood concentration was significantly higher in females than in males （P〈0.05）.At other time period, there were no significant differences in dose and blood concentration between male and female patients.The dose in the elder age group （age〉45 years） was lower than that in younger age group （16-45 years old） over the same period after transplantation, the difference was significant during 3-6 months （P〈0.05）.The polymorphism of CYP3A5＊3 gene showed a great influence on FK506 blood concentration in renal transplant recipients.At the same time after operation, the FK506 dosage of patients with CYP3A5＊1＊1 genotype was higher than that with CYP3A5＊1＊3 and CYP3A5＊3＊3 （P〈0.05）, and the blood concentration of patients with CYP3A5＊1＊1 was lower than that with CYP3A5＊1＊3 and CYP3A5＊3＊3 （P〈0.05）. Conclusion The detection of FK506 blood concentration and gene polymorphism can reduce the occurrence of excessive/insufficient immunity, and adverse drug reactions, and improve the long-term survival rate of transplanted kidney.

关 键 词：他克莫司 基因多态性 血药浓度 肾移植患者 

分 类 号：R979.5[医药卫生—药品] R617[医药卫生—药学]