他克莫司个体内变异性与心脏移植术后预后的关系  

Relationship between tacrolimus intra-individual variability and post-heart transplant outcomes

作　　者：朱鑫瀛[1] 段正伟[1] 袁超[1] ZHU Xinying;DUAN Zhengwei;YUAN Chao(Cardiac Surgery ICU,the Seventh People’s Hospital of Zhengzhou,Zhengzhou 450016,China)

机构地区：[1]郑州市第七人民医院心外科重症监护室,郑州450016

出　　处：《上海医药》2025年第3期38-40,92,共4页Shanghai Medical & Pharmaceutical Journal

摘　　要：目的:探讨他克莫司个体内变异性(IPV)与心脏移植术后预后的关系。方法:回顾性分析98例心脏移植术后接受他克莫司治疗患者的临床资料,根据校正后血药浓度波动程度分为高IPV组(n=34)和低IPV组(n=64),比较2组他克莫司血药浓度(C0)、日剂量、术后心脏功能及感染、排斥反应和死亡发生率。结果:2组他克莫司平均血药浓度、日剂量及术后3和12个月左心室射血分数(LVEF)、左心室收缩末期内径(LVESD)、左心室舒张末期内径(LVEDD)等心脏功能指标无显著差异(均P>0.05)。高IPV组IPV水平高于低IPV组,且至少有1次C0<8 ng/mL或C0>12 ng/mL的发生率以及术后感染发生率也更高(均P<0.05),但排斥反应和死亡发生率无显著差异(均P>0.05)。结论:他克莫司个体内高变异性是心脏移植术后感染风险升高的危险因素,但对排斥反应及死亡发生率无显著影响。Objective:To investigate the relationship between tacrolimus intra-individual variability(IPV)and postheart transplant outcomes.Methods:Clinical data from 98 heart transplant recipients treated with tacrolimus were retrospectively analyzed.The patients were divided into a high IPV group(n=34)and a low IPV group(n=64)based on corrected blood concentration fluctuations.The blood concentration(C0)and daily dose of tacrolimus,the cardiac function,the incidences of infection,rejection and mortality after surgery were compared between the two groups.Results:There were no significant differences between the two groups in the average blood concentration and daily dose of tacrolimus and the cardiac function parameters(LVEF,LVESD,LVEDD)at 3 or 12 months post-transplant(all P>0.05).The high IPV group had higher IPV levels and postoperative infection rate and at least once occurrence of C0<8 ng/mL or>12 ng/mL,however,there were no statistically significant differences in rejection or mortality rates(all P>0.05).Conclusion:High intra-individual variability of tacrolimus is a risk factor for increased post-operative infection in heart transplant recipients but has no significant impact on rejection or mortality.

关 键 词：他克莫司 个体内变异性 心脏移植术 预后 

分 类 号：R979.5[医药卫生—药品] R617[医药卫生—药学]