FK506血药浓度与肾移植患者肝肾等功能的关联关系探讨  

Effects of FK506 concentration on liver and kidney function in renal transplant patients

作　　者：门莎莎[1] 南京柱[1] 洪权[2] 张明华[3] 董矜[1] MEN Shasha;NAN Jingzhu;HONG Quan;ZHANG Minghua;DONG Jin(Department of Clinical Laboratory,the First Medical Center,Chinese PLA General Hospital,Beijing 100853,China;National Clinical Research Center for Kidney Diseases&State Key Laboratory of Kidney Diseases,the First Medical Center,Chinese PLA General Hospital,Beijing 100853,China;Clinical Pharmacy Laboratory,Chinese PLA General Hospital,Beijing 100853,China)

机构地区：[1]解放军总医院第一医学中心检验科,北京100853 [2]解放军总医院第一医学中心肾脏病医学部,北京100853 [3]解放军总医院临床药学实验室,北京100853

出　　处：《解放军医学院学报》2022年第8期845-849,共5页Academic Journal of Chinese PLA Medical School

摘　　要：背景他克莫司(tacrolimus,又称FK506、TAC)是常用于预防肾移植或其他移植中排斥反应的免疫抑制剂,临床需定期监测药物浓度,但患者维持稳定药物浓度后,机体变化状态则较少报道。目的评估FK506血药浓度对肾移植患者肝肾功能等影响。方法回顾性分析2019年10-12月解放军总医院第一医学中心192例肾移植术后患者临床资料;以术后1年内FK506血药浓度进行四分位数分层,比较各组年龄、肝肾功能、血常规等指标差异。结果四分位组中位(IQR)药物浓度由低至高依次为Q1:4.00(2.95~4.45)ng/L(n=52,其中女性14例),Q2:5.20(5.00~5.30)ng/L(n=49,其中女性17例),Q3:6.20(5.85~6.40)ng/L(n=46,其中女性19例),Q4:7.90(7.50~9.00)ng/L(n=45,其中女性15例)(P=0.517)。四组中位(IQR)年龄依次为49.0(42.0~57.0)岁、45.0(36.0~56.0)岁、45.5(37.0~53.0)岁、40.0(32.0~47.0)岁(P<0.05)。四组间比较呈现统计学差异的有估算肾小球滤过率、尿素和肌酐(P均<0.05)。在男性组中,随FK506浓度的升高,尿素、肌酐呈现下降趋势,估算肾小球滤过率和红细胞总数呈现上升趋势(P<0.05);而在女性组中,这些指标差异均无统计学意义(P>0.05)。男性FK506水平与肾功能(尿素、肌酐,估算肾小球滤过率)呈正相关(P<0.05);而在女性中,FK506与各指标相关性差异均无统计学意义(P>0.05)。结论在肾移植术后肾功能监测中,男性患者受FK506浓度变化的影响较大,提示FK506对肾功能的保护作用可能因性别而异,在给药和监测中应注意性别差异。Background As an immunosuppressant,tacrolimus(also known as FK506,TAC)is often used to prevent rejection in renal transplantation or other transplantation.Due to the drug metabolism difference of FK506,the drug concentration needs to be monitored regularly in clinic.However,the change of body state is less reported after the patient maintains a stable drug concentration.Objective To investigate the effects of FK506 concentration on liver and kidney function in renal transplant patients.Methods Clinical data about 192 renal transplant patients with stable FK506 concentration within one year postoperatively were analyzed retrospectively in the First Medical Center of Chinese PLA General Hospital from October to December in 2019.The patients were divided into four groups according to the blood concentration of FK506 by quartile(Q1-Q4).The age,liver function,renal function and whole blood cells were evaluated.Results The median(IQR)drug concentration in the quartile group from low to high was 4.00(2.95,4.45)ng/L(n=52,including 14 women),5.20(5.00,5.30)ng/L(n=49,including 17 women),6.20(5.85,6.40)ng/L(n=46,including 19 women),7.90(7.50,9.00)ng/L(n=45,including 15 women)(P=0.517).The median(IQR)age of patients in the four groups was 49.0(42.0,57.0)years,45.0(36.0,56.0)years,45.5(37.0,53.0)years and 40.0(32.0,47.0)years(P<0.05).eGFR,urea and creatinine showed significant differences among the four groups(all P<0.05).In male group,with the increase of FK506 concentration,urea and creatinine decreased;eGFR and RBC increased(all P<0.05);In female group,there was no significant difference in these indexes(P>0.05).There was positive correlations between FK506 level and renal function indexes(urea,creatinine,eGFR)levels(all P<0.05)in male group.In female group,the correlations between FK506 and all these indexes were not statistically significant(P>0.05).Conclusion On monitoring of renal function after renal transplantation,male patients is prone to be affected to the changes of FK506 concentration,which indicates that protec

关 键 词：治疗药物监测 他克莫司(FK506) 肾移植 血液化学分析 性别 

分 类 号：R979.5[医药卫生—药品]