重症肌无力患者他克莫司血药浓度监测与CYP3A5基因检测分析  

Analysis of tacrolimus blood concentration monitoring and CYP3A5 gene detection in myasthenia gravis patients

作　　者：陈頔[1] 张华[2] 殷剑[2] 田晓鑫[1] 侯世芳[2] 赵明[1] 杨莉萍[1] CHEN Di;ZHANG Hua;YIN Jian;TIAN Xiaoxin;HOU Shifang;ZHAO Ming;YANG Liping(Department of Pharmacy,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing Key Laboratory of Drug Risk and Personalized Medication Evaluation,Beijing 100730,China)

机构地区：[1]北京医院药学部国家老年医学中心,中国医学科学院老年医学研究院,药物临床风险与个体化应用评价北京市重点实验室,100730 [2]北京医院神经内科,国家老年医学中心,中国医学科学院老年医学研究院,100730

出　　处：《中国神经免疫学和神经病学杂志》2020年第3期206-209,218,共5页Chinese Journal of Neuroimmunology and Neurology

基　　金：北京市科学技术委员会首都临床诊疗技术研究及示范应用项目资助(Z191100006619015);北京医院院级科研课题(bj-2018-014、bj-2019-182)。

摘　　要：目的分析重症肌无力(MG)患者他克莫司血药浓度的影响因素,为个体化用药提供参考。方法收集2015年1月至2018年12月作者医院使用他克莫司治疗的MG患者258例,并收集患者的临床资料。采用化学发光微粒子免疫分析法测定他克莫司血药浓度,荧光染色原位杂交检测患者CYP3A5*3基因多态性,采用多重线性回归法分析血药浓度与性别、年龄、体重、基因型、用药剂量、合并用药等因素的相关性。结果258例MG患者共进行378例次他克莫司谷浓度测定,平均浓度为(6.02±4.93)ng/mL。多重线性回归分析结果显示,他克莫司剂量、CYP3A5基因型、合并使用奥美拉唑或艾司奥美拉唑与他克莫司血药浓度存在相关性(均P<0.05)。结论MG患者他克莫司血药浓度受诸多因素影响,临床应充分考虑个体化因素。Objective To analyze the influencing factors for tacrolimus blood concentration in patients with myasthenia gravis(MG)and provide reference for individualized treatment.Methods The data of tacrolimus blood concentrations and medical records of 258 MG patients in the authors’hospital were collected from January 2015 to December 2018.Tacrolimus whole-blood concentrations were measured by chemiluminescent microparticle immunoassay and CYP3A5*3 gene polymorphism was detected by digital fluorescence molecule hybridization fluorescence.Regression analysis was applied to analyze the influencing factors for blood concentrations.Results The average concentration of 378 blood samples of 258 MG patients was(6.02±4.93)ng/mL.It was shown that the dosage of tacrolimus,CYP3A5*3 gene polymorphism and combination of omeprazole or esmeralprazole had correlation with tacrolimus blood concentration by multiple linear regression analysis(P<0.05).Conclusions The concentration of tacrolimus is affected by many factors,so when tacrolimus is used,multiple factors should be considered comprehensively to achieve individualized treatment.

关 键 词：重症肌无力 他克莫司 治疗药物监测 基因多态性 

分 类 号：R746.1[医药卫生—神经病学与精神病学]