他克莫司血药浓度对肾病综合征患者肝肾功能和血糖的影响  

Effect of blood concentration of tacrolimus on liver function,kidney function and blood glucose of patients with nephrotic syndrome

作　　者：王兰君[1] 靳隽[2] 李梦琪 张敏[1] WANG Lanjun;JIN Juan;LI Mengqi;ZHANG Min(Department of Clinical Laboratory,the First Affiliated Hospital of Xinxiang Medical University,Weihui 453100,Henan Province,China;College of Humanities,Xinxiang Medical University,Xinxiang 453003,Henan Province,China;Department of Medical Record,the First Affiliated Hospital of Xinxiang Medical University,Weihui 453100,Henan Province,China)

机构地区：[1]新乡医学院第一附属医院检验科,河南卫辉453100 [2]新乡医学院人文学院,河南新乡453003 [3]新乡医学院第一附属医院病案室,河南卫辉453100

出　　处：《新乡医学院学报》2022年第3期243-247,共5页Journal of Xinxiang Medical University

摘　　要：目的探讨肾病综合征患者他克莫司血药浓度变化及其对肝肾功能和血糖等指标的影响,为临床合理用药提供依据。方法选择2020年1月至2020年12月新乡医学院第一附属医院收治的153例肾病综合征患者为研究对象,所有患者予以他克莫司治疗,开始剂量为0.05 mg·kg^(-1)·d^(-1),分2次口服;同时给予醋酸泼尼松口服,初始剂量0.5 mg·kg^(-1)·d^(-1),治疗8周后每周减量10%,减至20 mg·d^(-1)后再持续治疗8周,然后每周减量10%,直至剂量维持在10.0 mg·d^(-1)。于连续服用他克莫司5 d后,抽取患者早晨服药前静脉血2 mL,应用美国雅培全自动免疫化学发光分析仪检测患者的他克莫司血药浓度,根据血药浓度分为高浓度(他克莫司血药浓度>10.0μg·L^(-1))组和低浓度(他可莫司血药浓度≤10.0μg·L^(-1))组;抽取患者静脉血3 mL,应用贝克曼5800全自动生化分析仪检测血糖(FBG)、丙氨酸转氨酶(ALT)、天门冬氨酸氨基转移酶(AST)、总胆红素(TBIL)、肌酐(Scr)、尿素氮(BUN)水平。观察2组患者不良反应发生情况。结果9例(5.9%)患者的他克莫司血药浓度<5μg·L^(-1),68例(44.4%)患者的他克莫司血药浓度分布在5~10μg·L^(-1),59例(38.6%)患者的他克莫司血药浓度分布在>10~15μg·L^(-1),17例(11.1%)患者的他克莫司血药浓度>15μg·L^(-1)。高浓度组76例,男45例(59.2%),女31例(40.8%);年龄16~75(47.59±16.25)岁。低浓度组77例,男38例(49.4%),女39例(50.6%);年龄17~78(43.31±17.80)岁。2组患者年龄、性别分布比较差异无统计学意义(P>0.05)。高浓度组患者的血ALT、Scr、BUN、FBG水平显著高于低浓度组(P<0.05);2组患者的血AST和TBIL水平比较差异无统计学意义(P>0.05)。Pearson相关分析显示,他克莫司血药浓度与Scr、BUN、FBG呈中等程度正相关(r=0.489、0.434、0.468,P<0.05),与ALT呈弱正相关(r=0.187,P<0.05),与AST和TBIL无相关性(r=-0.019、-0.014,P>0.05)。低浓度组患者发生肾功能损伤2例,高�Objective To investigate the change of blood concentration of tacrolimus in patients with nephrotic syndrome and its effect on the liver function,kidney function and blood glucose,so as to provide an evidence for clinical rational drug use.Methods A total of 153 patients with nephrotic syndrome admitted to the First Affiliated Hospital of Xinxiang Medical University from January 2020 to December 2020 were selected as the research subjects,and tacrolimus was given orally,with the initial dose of 0.05 mg·kg^(-1)·d^(-1),oral administration in two doses.At the same time,prednisone acetate was given orally,with the initial dose of 0.5 mg·kg^(-1)·d^(-1),and the dose was reduced by 10%per week to 20 mg·d^(-1) after 8 weeks of treatment,and then decreased by 10%per week after 8 weeks of treatment,until the dose was maintained at 10.0 mg·d^(-1).Five days after treatment of tacrolimus continuously,2 milliliter of venous blood of patients before taking the medicine in the morning was extracted,and the blood concentration of tacrolimus of patients was detected by Abbott automatic immunity immunochemiluminescence analyzer,the patients were divided into high concentration(the blood concentration of tacrolimus>10μg·L^(-1))group and low concentration(the blood concentration of tacrolimus≤10μg·L^(-1))group accroding to the blood concentration.Three milliliter of venous blood was extracted,and the levels of fasting blood glucose(FBG),alanine transaminase(ALT),aspartate transaminase(AST),total bilirubin(TBIL),serum creatinine(Scr)and blood urea nitrogen(BUN)were detected by BECKMAN 5800 automatic biochemical analyzer.The adverse reactions of patients in the two groups were observed.Results The blood concentration of tacrolimus in 9 cases(5.9%)was lower than 5μg·L^(-1),the blood concentration of tacrolimus in 68 cases(44.4%)was distributed from 5 to 10μg·L^(-1),the blood concentration of tacrolimus in 59 cases(38.6%)was distributed from 10 to 15μg·L^(-1),and the blood concentration of tacrolimus in 17 cases(11.0%)w

关 键 词：肾病综合征 他克莫司 血药浓度 肝肾功能 血糖 

分 类 号：R692[医药卫生—泌尿科学]