他克莫司胶囊致肾移植围术期患者急性肾损伤病例分析及文献复习  

Case analysis of acute kidney injury caused by tacrolimus capsules in a perioperative patient with kidney transplantation and literature review

作　　者：吴小山 任桂灵 WU Xiaoshan;REN Guiling(Department of Pharmacy,the First Hospital affiliated to USTC,Hefei 230001,China;Department of Pharmacy,the 901 Hospital of Chinese People’s Liberation Army Joint Service Support Unit,Hefei 230031,China)

机构地区：[1]中国科学技术大学附属第一医院(安徽省立医院)药学部,合肥230001 [2]中国人民解放军联勤保障部队第九〇一医院药剂科,合肥230031

出　　处：《上海医药》2025年第2期63-66,80,共5页Shanghai Medical & Pharmaceutical Journal

基　　金：安徽省自然科学基金青年项目(1908085QH377);第901医院科研项目(2024YGYJ02)。

摘　　要：目的:探讨肾移植围术期患者使用他克莫司的肾毒性,为临床安全用药提供参考。方法:通过医院HIS系统收集1例肾移植围术期发生急性肾损伤患者的相关信息,对患者急性肾损伤与他克莫司血药浓度过高的关联性进行评价。结果:患者术后D3他克莫司C_(0)达40.60 ng/mL,遂停药。D16患者小便量降低至100 mL,肾穿刺示弥漫性肾小管上皮损伤,予谷胱甘肽对症处理后小便恢复正常。患者急性肾损伤与他克莫司血药浓度过高相关性评估为很可能。结论:他克莫司血药浓度过高引起的急性损伤在早期通过降低其血药浓度和对症处理后基本可逆转。Objective:To explore the nephrotoxicity of tacrolimus in a perioperative patient with kidney transplantation to provide a reference for the clinically safe medication.Methods:The information about this patient was collected by the HIS system and then the association between acute kidney injury and excessive tacrolimus blood concentrations was evaluated.Results:The tacrolimus concentration at C_(0) on postoperative D3 reached 40.60 ng/mL and then tacrolimus was discontinued.The urine volume on postoperative D16 was reduced to 100 mL,the renal puncture showed diffuse tubular epithelial injury,and the urine volume returned to normal after symptomatic treatment with glutathione.The correlation between acute kidney injury and tacrolimus levels was assessed as probable.Conclusion:Acute injuries caused by high blood concentrations of tacrolimus are largely reversible early by a decrease of blood concentrations and symptomatic management.

关 键 词：肾移植 他克莫司 治疗药物监测 药物不良反应 急性肾损伤 

分 类 号：R979.5[医药卫生—药品] R969.3[医药卫生—药学]