CAJ | 학술논문

目的分析我院肾移植患者他克莫司血药浓度的控制情况,探讨他克莫司血药浓度与肝肾功能之间的关系,以期为临床的合理用药提供依据。方法收集我院2011年11月至2013年4月96例肾移植患者他克莫司血药浓度的数据,及血药浓度测定当天的生化检测结果。根据他克莫司血药浓度(A)测定结果,将其分为4组(I组,A≤6 ng/mL；II组,6<A≤10 ng/mL；III组,10<A≤15 ng/mL；IV组,A>15 ng/mL),对4组中的各项生化指标及不良反应比例进行统计分析。结果红细胞(P=0.57),血红蛋白(P=0.60),血小板(P=0.12),总胆红素(P=0.58),谷氨酰基转移酶(P=0.46),天门冬氨酸氨基转移酶(P=0.98)和丙氨酸氨基转移酶(P=0.40)在4组之间没有统计学意义；而白细胞(P=0.007),碱性磷酸酶(P=0.004)和血尿素氮(P=0.007)在4组之间差异有统计学意义。当患者的他克莫司血药浓度维持在6~15 ng/mL 时,其肾小球滤过率估计值(estimated glo-merular filtration rate,eGFR)(70.2 mL/min)要明显高于≤6 ng/mL(58.2 mL/min)和>15 ng/mL (66.2 mL/min)。同时,感染及中重度贫血的风险也较低,但他克莫司血药浓度与肝功能异常比例之间未发现显著的相关性。结论他克莫司血药浓度维持在6~15 ng/mL有利于患者肾功能的维持,同时能够降低感染和中重度贫血的风险,这一结果将有利于他克莫司的临床使用。
목적분석아원신이식환자타극막사혈약농도적공제정황,탐토타극막사혈약농도여간신공능지간적관계,이기위림상적합리용약제공의거。방법수집아원2011년11월지2013년4월96례신이식환자타극막사혈약농도적수거,급혈약농도측정당천적생화검측결과。근거타극막사혈약농도(A)측정결과,장기분위4조(I조,A≤6 ng/mL；II조,6<A≤10 ng/mL；III조,10<A≤15 ng/mL；IV조,A>15 ng/mL),대4조중적각항생화지표급불량반응비례진행통계분석。결과홍세포(P=0.57),혈홍단백(P=0.60),혈소판(P=0.12),총담홍소(P=0.58),곡안선기전이매(P=0.46),천문동안산안기전이매(P=0.98)화병안산안기전이매(P=0.40)재4조지간몰유통계학의의；이백세포(P=0.007),감성린산매(P=0.004)화혈뇨소담(P=0.007)재4조지간차이유통계학의의。당환자적타극막사혈약농도유지재6~15 ng/mL 시,기신소구려과솔고계치(estimated glo-merular filtration rate,eGFR)(70.2 mL/min)요명현고우≤6 ng/mL(58.2 mL/min)화>15 ng/mL (66.2 mL/min)。동시,감염급중중도빈혈적풍험야교저,단타극막사혈약농도여간공능이상비례지간미발현현저적상관성。결론타극막사혈약농도유지재6~15 ng/mL유리우환자신공능적유지,동시능구강저감염화중중도빈혈적풍험,저일결과장유리우타극막사적림상사용。
Objective Inordertopromotetherationaluseoftacrolimus,theeffectsofdrug bloodconcentrationsonkidneyandliverfunctionswereanalyzed.Methods Ninety-sixkidneytrans-plant recipients between December 201 1 and April 2013 were enrolled in this study.According to the range of tacrolimus blood concentrations,four groups were subdivided,and the corresponding clinical parameterswererecordedandanalyzed.Results Therewerenosignificantdifferencesamongfour groups in RBC (P=0.57),HGB (P=0.6),PLT (P=0.12),TBIL (P=0.58),GGT (P=0.46), AST (P=0.98)and ALT (P=0.40).However,significant differences were observed in WBC (P=0.007),ALP (P=0.004)and BUN (P=0.007).For the kidney transplant recipients,6-15 ng/mL might be an appropriate range for tacrolimus.Allograft function,evaluated by estimated glomerular filtration rate (eGFR),in the range of 6-15 ng/mL (eGFR 70.2 mL/min)was significantly better than that in the ranges of≤ 6 ng/mL (eGFR 58.2 mL/min)and >15 ng/mL (eGFR 66.2 mL/min). Meanwhile,patients had low risks of moderate/severe anemia and infection when TTC was maintained in the range of 6-1 5 ng/mL.There was no significant correlation between tacrolimus blood concentra-tionandtherateofliverdysfunction.Conclusions Thepatientscouldmaintaintherelativenormalkid-ney function,and have low risks of adverse events when tacrolimus blood concentration was in the range of 6-1 5 ng/mL.The results might be useful for the clinical application of tacrolimus.