肾移植伴腹泻患者他克莫司血药谷浓度变化的回顾性分析  

A retrospective study of tacrolimus trough level changes in renal transplant recipients with diarrhea

作　　者：姚青青 丁肖梁[1] 张彦[1] 石金芳[1] 高杰[1] YAO Qingqing;DINGXiaoliang;ZHANGYan;SHI Jinfang;GAO Jie(Department of Pharmacy,The First Affiliated Hospital of Soochow University,Jiangsu Suzhou 215000,China)

机构地区：[1]苏州大学附属第一医院药学部,江苏苏州215000

出　　处：《中国医院药学杂志》2024年第15期1785-1789,共5页Chinese Journal of Hospital Pharmacy

基　　金：国家自然科学基金(编号:81903716)。

摘　　要：目的:探讨肾移植伴腹泻患者他克莫司血药谷浓度的变化情况,为患者安全用药提供依据。方法:收集2013年1月至2023年5月在苏州大学附属第一医院收治的接受他克莫司治疗的肾移植伴腹泻患者的病历信息,比较腹泻前、腹泻期间和腹泻后他克莫司血药谷浓度、给药剂量和相关实验室检验指标的变化。结果:共纳入18例患者,男性13例,女性5例,年龄21~66岁,中位移植时间36.0(11.5,44.0)个月。腹泻时他克莫司血药谷浓度、血药谷浓度与剂量比值均显著升高(P<0.05),其中5例他克莫司血药谷浓度>15 ng·mL^(-1)。根据治疗药物监测结果,11例进行他克莫司剂量调整,减量0.5~2 mg·d^(-1)。腹泻时所有患者的肝肾功能指标、血清白蛋白和红细胞比积较腹泻前后变化差异均无统计学意义(P>0.05)。但在腹泻期间,9例患者的血清肌酐出现一过性升高,其中1例合并谷丙转氨酶和谷草转氨酶一过性升高,1例合并谷草转氨酶一过性升高,异常指标在腹泻后恢复至基线水平。结论:肾移植患者出现腹泻时他克莫司血药谷浓度升高,建议加强他克莫司治疗药物监测,必要时调整他克莫司给药剂量。OBJECTIVE To explore the changes of tacrolimus trough levels in renal transplant(RT)recipients with diarrhea and provide rationales for the dosing safety of medication.METHODS From January 2013 to May 2023,retrospective survey was conducted for 18 RT patients with diarrhea.Further analysis was performed to compare the changes in tacrolimus trough levels,administered doses and related parameters before,during and after diarrhea.RESULTS There were 13 males and 5 females with an age range of(21-66)year.Median transplantation time was 36.0(11.5,44.0)month.Both tacrolimus blood trough concentration and blood trough concentration/administered dose spiked markedly during diarrhea(P<0.05).Tacrolimus blood trough concentration exceeded 15 ng·mL^(-1)(n=5).For patient safety,dose adjustment was performed based upon therapeutic drug monitoring with a reduction of 0.5~2 mg·d^(-1)(n=11).No significant differences existed in heptorenal function parameters,serum albumin and hematocrit before and after diarrhea(P>0.05).Transient elevation of serum creatinine occurred during diarrhea(n=9),including a transient elevation of alanine transaminase and aspartate transaminase(n=1)and a transient increase in aspartate transaminase(n=1).All abnormal parameters nromalized after diarrhea.CONCLUSION Close therapeutic drug monitoring and early tacrolimus dose adjustment are strongly recommended for RT patients with diarrhea to ensure medication safety.

关 键 词：肾移植 他克莫司 腹泻 治疗药物监测 

分 类 号：R282[医药卫生—中药学] R979.5[医药卫生—中医学]