基于TDM与基因检测指导1例患者应用他克莫司的案例分享  

TDM and Genetic Testing Technology Guided A Case of Tacrolimus Application

作　　者：罗茜华 孟冬梅[1] 周立成 苏思曼 黎丽 陈云 刘苏麟[4] 张述耀 陈肖珊 LUO Qianhua;MENG Dongmei;ZHOU Licheng;SU Siman;LI Li;CHEN Yun;LIU Sulin;ZHANG Shuyao;CHEN Xiaoshan(The First Affiliated Hospital of Guangzhou Medical University,Guangzhou,Guangdong 510120,China;Guangzhou Red Cross Hospital,Guangzhou,Guangdong 510235,China;Shantou University Medical College,Shantou,Guangdong 515041,China;The First Affiliated Hospital of Shantou University Medical College,Shantou,Guangdong 515041,China)

机构地区：[1]广州医科大学附属第一医院,广东广州510120 [2]广州市红十字会医院,广东广州510235 [3]汕头大学医学院,广东汕头515041 [4]汕头大学医学院第一附属医院,广东汕头515041

出　　处：《今日药学》2023年第7期548-551,共4页Pharmacy Today

摘　　要：目的协助临床医师为患者实施个体化用药,提高患者药物治疗效果,也为临床药师开展个体化药学服务提供参考意见。方法运用药物基因多态性联合血药浓度监测等技术对1例肺移植患者术后服用他克莫司出现症状样癫痫不良反应进行详细分析。结果患者血清肌酐水平与他克莫司浓度高度相关(P<0.05),患者他克莫司的谷浓度与红细胞计数之间存在高度的相关性(P<0.05),该患者CYP3A5基因型为*3/*3,提示为慢代谢类型,他克莫司清除速率降低。结论他克莫司属于窄治疗窗的药物,剂量或血药浓度的较小变化即可引起严重不良反应或治疗失败,且个体差异显著,根据该患者的监测,患者出现症状样癫痫很可能是由他克莫司引起的,而且他克莫司血药浓度与其导致的中枢神经系统不良反应不一定呈正相关。OBJECTIVE To assist clinicians individualized medication for patients,improve the effect of drug treatment in patients,also provide the reference for clinical pharmacists in individualized pharmaceutical care.METHODS Drug gene polymorphism combined blood concentration monitoring technology were used for a case of lung transplantation patient with postoperative tacrolimus symptom like epilepsy adverse reactions for detailed analysis.RESULTS The serum creatinine level of the patient was highly correlated with the concentration of tacrolimus(P0.05),and there showed high correlation between the valley concentration of tacrolimus and red blood cell count(P0.05).The CYP3A5 genotype of the patient was*3/*3,indicating a slow metabolism type and decrease in tacrolimus clearance rate.CONCLUSION Tacrolimus has a narrow treatment window,minor change of dosage or blood drug concentration may cause adverse reactions or treatment failure,and affect significant individual differences.According to the patient's monitoring,symptomatic epilepsy is likely caused by tacrolimus,and there may not show positive correlation between tacrolimus blood concentration and the adverse reactions it causes in the central nervous system.

关 键 词：肺移植 基因多态性检测 血药浓度 他克莫司 症状样癫痫 

分 类 号：R969[医药卫生—药理学]