药物相互作用对肾移植受者霉酚酸体内暴露量的影响  

Effects of drug interactions on in vivo exposure of mycophenolic acid in renal transplant recipients

作　　者：张寒娟[1] 丁建强[2] 韩文超 陈永妍[1] 丁蕊 王高彪 李雪 ZHANG Han-juan;DING Jian-qiang;HAN Wan-chao;CHEN Yong-yan;DING Rui;WANG Gao-biao;LI Xue(Department of Pharmacy,Zhengzhou the Seventh People's Hospital,Zhengzhou 450016,China;Department of Pharmacy,Henan General Hospital of Armed Police,Zhengzhou 450000,China)

机构地区：[1]郑州市第七人民医院药学部,郑州450016 [2]武警河南总队医院药学部,郑州450000

出　　处：《医药论坛杂志》2023年第21期90-94,共5页Journal of Medical Forum

基　　金：河南省医学科技攻关计划联合共建项(LHGJ20200732)。

摘　　要：目的分析合并用药对肾移植患者霉酚酸体内暴露量的影响,为吗替麦考酚酯(MMF)的临床合理应用提供参考。方法采用回顾性研究方法,对郑州市第七人民医院肾移植科使用MMF治疗并测定浓度的住院患者进行信息归纳,从浓度分布情况,抑制胃酸分泌药物、抗病毒药物、CNI类药物对霉酚酸暴露量的影响等方面进行分析探讨。结果肾移植科霉酚酸AUC_(0~12 h)在30~60μg(h/mL)范围内占58.39%;谷浓度与霉酚酸AUC_(0~12 h)呈正相关的趋势(r=0.804,P=0.000);合用抑制胃酸分泌药物未见对霉酚酸AUC_(0~12 h)产生明显影响;更昔洛韦可以降低霉酚酸AUC_(0~12 h)(U=12936.5,Z=-2.442,P=0.015);合用他克莫司组的霉酚酸AUC_(0~12 h)显著高于合用环孢素组(U=3916.0,Z=-4.698,P=0.000)。结论霉酚酸体内暴露量与谷浓度有一定的相关性,但是不能通过谷浓度估算出来;合用抑制胃酸分泌药物不影响霉酚酸体内暴露量;合用更昔洛韦降低霉酚酸体内暴露量;不同抗排斥方案霉酚酸体内暴露量存在差异。Objective This study analyzes the effect of concomitant medication on the in vivo exposure of mycophenolic acid in patients with renal transplantation,and it provide reference for the rational clinical application of mycophenolate mofetil(MMF).Methods A retrospective study method was used to summarize the information of inpatients treated with MMF and measured their concentrations in the renal transplantation department of Zhengzhou No.7 People's Hospital.The impact on the exposure of mycophenolic acid were analyzed and discussed from the concentration distribution,the effects of gastric acid secretion-inhibiting drugs,antiviral drugs,and CNI drugs.Results The AUC_(0~12 h)of mycophenolic acid in the range of 30-60μg(h/mL)accounted for 58.39%;The trough concentration was positively correlated with the AUC_(0~12 h)of mycophenolic acid(r=0.804,P=0.000);Combination of drugs that inhibit gastric acid secretion has no significant effect on mycophenolic acid AUC_(0~12 h);Ganciclovir can reduce mycophenolic acid AUC_(0~12 h)(U=12936.5,Z=-2.442,P=0.015);The AUC_(0~12 h)of mycophenolic acid in the crolimus group was significantly higher than that of the combined cyclosporine group(U=3916.0,Z=-4.698,P<0.001).Conclusion There is a certain correlation between the exposure of mycophenolic acid in vivo and the trough concentration,but it cannot be estimated by the trough concentration;the combination of drugs that inhibit gastric acid secretion does not affect the in vivo exposure of mycophenolic acid;the combination of ganciclovir reduces the vivo exposure of mycophenolic acid;there are differences in the in vivo exposure of mycophenolic acid in different anti-rejection regimens.

关 键 词：霉酚酸体内暴露量 更昔洛韦 质子泵抑制剂 他克莫司 

分 类 号：R699.2[医药卫生—泌尿科学]