肾移植术后咪唑立宾疗效和不良反应与其浓度、剂量和用药时长的相关性研究  

Correlation between efficacy and adverse reactions of mizoribine and its concentration,dose and duration of administration in patients after renal transplantation

作　　者：陈晨 岳慧杰 黄晓晖 李雪 谢轲楠 倪雪峰 陈劲松 CHEN Chen;YUE Hui-jie;HUANG Xiao-hui;LI Xue;XIE Ke-nan;NI Xue-feng;CHEN Jing-song(Department of Clinical Pharmacy,General Hospital of Eastern Theater Command,Nanjing 210002,China;National Clinical Research Center of Kidney Diseases,General Hospital of Eastern Theater Command,Nanjing 210002,China)

机构地区：[1]东部战区总医院临床药学科,江苏南京210002 [2]东部战区总医院国家肾脏疾病临床医学研究中心,全军肾脏病研究所,江苏南京210002

出　　处：《实用药物与临床》2021年第5期405-408,共4页Practical Pharmacy and Clinical Remedies

基　　金：江苏省青年基金项目(BK20180292)。

摘　　要：目的探讨肾移植术后患者使用咪唑立宾抗排斥治疗的安全性和临床疗效,探究其与浓度、剂量和用药时长的相关性,为临床安全合理用药提供参考。方法采用回顾性调查分析方法,收集我院2015年12月至2019年11月肾移植术后使用咪唑立宾抗排斥治疗的病例,统计咪唑立宾用药后1个月、3个月、6个月、9个月和12个月时肝肾功能、血常规的变化情况以及排斥反应的发生率,分析肝肾功能、血常规变化情况及排斥反应的发生率与咪唑立宾血药浓度、体重剂量、用药时长之间的相关性。结果共收集34例患者,有4例患者发生了排斥反应,发生率为11.76%。与用药前相比,用药后5个时间点血尿酸水平显著升高(P<0.01),且血尿酸、血肌酐水平与咪唑立宾血药浓度呈显著相关(P<0.01),咪唑立宾高浓度组的血尿酸和血肌酐水平显著高于正常浓度组。用药9个月后,血红蛋白水平显著增加(P<0.05),转氨酶、白细胞等未见明显变化。结论咪唑立宾是一种安全有效的免疫抑制剂,肾移植患者使用后的主要不良反应是血尿酸和血肌酐升高,可用血药浓度来预测其不良反应的发生风险。Objective To investigate the safety and efficacy of mizoribine in patients after renal transplantation,and to study its correlation with concentration,dose and duration of administration so as to provide references for the safe and rational use of mizoribine.Methods The data of patients using mizoribine after renal transplantation from December 2015 to November 2019 in our hospital were collected to make a retrospective analysis.The changes in liver and renal function and blood routine at 1 month,3 months,6 months,9 months and 12 months after using mizoribine,and the incidence of rejection reaction were calculated.Then we analyzed the correlation between them and the concentration,dose and duration of administration of mizoribine.Results A total of 34 cases were collected.Rejection reaction occurred in 4 patients with an incidence of 11.76%.The levels of serum uric acid were significantly increased at the 5 time points after the medication(P<0.01),and the levels of serum uric acid and creatinine were significantly correlated with the serum concentration of mizoribine(P<0.01).The levels of serum uric acid and creatinine in the high-concentration group were significantly higher than those in the normal-concentration group.After 9 months of the medication,the levels of hemoglobin were significantly increased(P<0.05),but no significant changes were found in transaminase or white blood cells.Conclusion Mizoribine is a safe and effective immunosuppressant.The main adverse reactions of mizoribine after renal transplantation are increased levels of serum uric acid and creatinine,whose risk can be predicted by the serum concentration.

关 键 词：肾移植 免疫抑制剂 咪唑立宾 血药浓度 

分 类 号：R699.2[医药卫生—泌尿科学]