他克莫司个体内变异性与心脏移植预后的相关性分析  

Correlation between intra-individual variability of tacrolimus and the prognosis of heart transplantation

作　　者：王真珍 郑华[1] 刘云霏 陈建超 曾东[1] 王长安[3] 郭琳[1] 杨斌[2] WANG Zhenzhen;ZHENG Hua;LIU Yunfei;CHEN Jianchao;ZENG Dong;WANG Chang'an;GUO Lin;YANG Bin(Department of Critical Care Medicine,Zhengzhou Seventh People's Hospital,Zhengzhou 450003,China;不详)

机构地区：[1]郑州市第七人民医院重症医学科,郑州450003 [2]郑州市第七人民医院心外科,郑州450003 [3]郑州市第七人民医院肾移植肾内科,郑州450003

出　　处：《实用医学杂志》2022年第24期3145-3149,3154,共6页The Journal of Practical Medicine

基　　金：河南省医学科技攻关计划联合共建项目(编号:LHGJ20210747)。

摘　　要：目的评价他克莫司个体内变异性(IPV)与心脏移植术后感染、排斥及死亡的相关性。方法收集2018年4月至2021年10月郑州市第七人民医院心脏移植受者术后第3~6个月的他克莫司谷浓度(C0),剂量校正后计算他克莫司IPV,根据平均值分为高IPV组和低IPV组,比较两组受者预后差异。结果共纳入102例受者,IPV平均值为26.8%。相对于低IPV组,高他克莫司IPV组的至少一次C0在治疗目标(8~12 ng/mL)范围之外的受者比例更高(<8 ng/mL:80.5%vs.39.3%,χ^(2)=16.836,P<0.001;>12 ng/mL:85.4%vs.47.5%,χ^(2)=15.007,P<0.001)。高IPV组受者的感染发生率高于低IPV组(34.2%vs.16.4%),率差及95%置信区间为17.8%(0.52%~34.99%),差异有统计学意义(χ^(2)=4.295,P=0.038)。排斥反应和死亡方面,两组组间比较差异无统计学意义(均P>0.05)。感染、排斥或者死亡其中之一即复合终点,两组比较具差异有统计学意义(18.03%vs.39.02%,χ^(2)=5.551,P=0.018)。结论高他克莫司IPV的心脏移植受者可能更容易发生感染,他克莫司IPV简便易得,可作为识别移植术后较差预后的随访工具。Objective To evaluate the association between tacrolimus intra-patient variability(IPV)and infection,rejection and death after heart transplantation.Methods Tacrolimus trough concentration(C0)was collected from heart transplant recipients in Zhengzhou Seventh People’s Hospital from April 2018 to October 2021at 3~6 months after surgery.IPV was calculated after dose correction,and patients were divided into the high IPV group and the low IPV group.Results A total of 102 patients were enrolled,with an average IPV of 26.8%.Compared with the low IPV group,the proportion of recipients with at least one C0 outside the treatment target(8 to 12 ng/mL)was higher in the high tacrolimus IPV group(<8 ng/mL:80.5%vs.39.3%,χ^(2)=16.836,P<0.001;>12 ng/mL:85.4%vs.47.5%,χ^(2)=15.007,P<0.001).The incidence of infection in the high IPV group was higher than that in the low IPV group(34.2%vs.16.4%),with a 95% confidence interval of 17.8%(0.52%~34.99%).The difference was statistically significant(χ^(2)=4.295,P=0.038).There was a statistically significant difference between the two groups in the combination of infection,rejection or death(18.03%vs.39.02%,χ^(2)=5.551,P=0.018).Conclusions The recipients with a high tacrolimus IPV may be more susceptible to infection after heart transplantation.Tacrolimus IPV is readily available and can be used as a follow-up tool to identify poor outcomes after transplantation.

关 键 词：心脏移植 他克莫司 个体内变异性 预后 

分 类 号：S857.134[农业科学—临床兽医学] R619.3[农业科学—兽医学]