肾病综合征患儿他克莫司血药浓度监测结果分析与临床效果评价  

Analysis and Clinical Effect Evaluation of Tacrolimus Plasma Concentration Monitoring in Children with Nephrotic Syndrome

作　　者：李玉柳 刘玉洁[1] 张书锋[1] 曹广海 魏磊[1] 刘钧菲[1] 刘翠华[1] LI Yu-liu;LIU Yu-jie;ZHANG Shu-feng;CAO Guang-hai;WEI Lei;LIU Jun-fei;LIU Cui-hua(Department of Nephrology Rheumatology and Immunology,Children's Hospital Affiliated to Zhengzhou University,Henan Children's Hospital,Zhengzhou Children's Hospital,Zhengzhou 450018,China)

机构地区：[1]郑州大学附属儿童医院,河南省儿童医院,郑州儿童医院肾脏风湿免疫科,郑州450018

出　　处：《中国合理用药探索》2021年第11期47-50,共4页Chinese Journal of Rational Drug Use

基　　金：河南省医学科技攻关计划联合共建项目(2018020663)。

摘　　要：目的:探讨肾病综合征患儿应用他克莫司血药浓度监测情况及临床效果,为临床合理用药提供参考依据。方法:回顾性汇总本院2018年1月~2020年7月收治并应用他克莫司的原发性肾病综合征患儿52例作为研究对象。记录年龄、性别、体重、他克莫司服药剂量和药物调整情况、血药浓度,以及应用他克莫司治疗前及治疗后4和8周的24 h尿蛋白定量、血生化指标,统计相关指标。结果:男性和女性患儿他克莫司血药浓度分别为(4.95±5.1)和(7.05±3.4)μg/L(P>0.05);幼儿期、学龄前期、学龄期和青春期他克莫司的血药浓度分别为(7.50±3.15)、(5.52±2.64)、(5.76±3.60)和(7.98±3.99)μg/L(P>0.05);幼儿期和青春期儿童给药剂量分别为(0.068±0.02)和(0.032±0.01)mg/kg(P<0.05)。52例患儿经激素联合他克莫司治疗8周,血液及尿液生化指标均改善。其中治疗后4和8周,24 h尿蛋白定量、总胆固醇水平低于治疗前,血清白蛋白水平高于治疗前,具有统计学差异(P<0.05);治疗后8周,24 h尿蛋白定量、总胆固醇水平低于治疗后4周,血清白蛋白水平高于治疗后4周,具有统计学差异(P<0.05)。结论:与幼儿期相比,青春期儿童给药剂量减少,不同性别和年龄组间他克莫司的血药浓度无统计学差异。他克莫司治疗儿童肾病综合征的临床疗效良好,但肾病综合征患儿血药浓度个体差异较大,在临床应用过程中需注意监测血药浓度,并根据血药浓度及临床疗效调整治疗方案。Objective:To investigate the monitoring result of the plasma concentrations and clinical effect of tacrolimus in children with nephrotic syndrome,so as to provide evidence for rational use of tacrolimus.Methods:A total of 52 children of primary nephrotic syndrome treated with tacrolimus from January 2018 to July 2020 in our hospital were selected as research subjects and retrospectively analyzed.Age,gender,weight,tacrolimus dosage and drug adjustment,plasma concentration,changes of 24-hour urinary protein and blood biochemical indexes before treatment and 4 and 8 weeks after treatment were recorded,and these indicators were descriptively counted.Results:The plasma concentrations of tacrolimus in male and female children were(4.95±5.1)and(7.05±3.4)μg/L(P>0.05);the plasma concentrations of tacrolimus in early childhood,preschool age,school age and adolescence were(7.50±3.15),(5.52±2.64),(5.76±3.60)and(7.98±3.99)μg/L(P>0.05);dosages of tacrolimus in early childhood and adolescent children were(0.068±0.02)and(0.032±0.01)mg/kg(P<0.05).After 8 weeks of treatment with corticosteroid and tacrolimus,the blood and urine biochemical indexes of 52 cases were significantly improved.After 4 weeks and 8 weeks of treatment,24-hour urine protein and total cholesterol levels were significantly lower than those before treatment,and serum albumin level was significantly higher than that before treatment,the difference was statistically significant(P<0.05).After 8 weeks of treatment,the 24-hour urine protein and total cholesterol levels were significantly lower than those after 4 weeks treatment,and the serum albumin level was significantly higher than that after 4 weeks treatment,the difference was statistically significant(P<0.05).Conclusion:Compared with early childhood,the dosage of tacrolimus in adolescent children was significantly reduced,and there was no significant difference in the plasma concentration of tacrolimus between different gender and age groups.The clinical efficacy of tacrolimus in the treatment of chi

关 键 词：他克莫司 肾病综合征 儿童 血药浓度 临床效果 

分 类 号：R969[医药卫生—药理学]