CAJ | 학술논문

目的：确定肾脏移植受者应用霉酚酸酯（MMF）的合理治疗窗浓度。方法选取110例肾移植受者分别于术后1月内、2~3个月、>4个月应用酶放大免疫分析技术测定口服MMF（分两次服用，间隔12 h）12 h后全血谷浓度（即MPA-C0），并观察受者用药期间急性排斥反应及药物毒副反应发生情况，对所有受者随访时间均为1年。结果统计资料显示，术后急性排斥反应发生率为13.64%（15/110），药物毒副反应发生率为32.73%（36/110），其中白细胞减少症12例，MMF相关性腹泻10例，感染10例，肝功能损害4例。发生急性排斥反应受者予甲基强的松龙冲击治疗后均成功逆转，药物毒副反应受者经治疗和（或）调整MMF剂量后病情恢复，无死亡病例及移植肾摘除病例。通过ROC曲线计算得出，MPA-C0控制在1.40~2.80 mg/L可较好避免肾移植术后急性排斥反应并减少受者的药物毒副反应。结论对肾移植术后服用MMF的受者进行MPA-C0监测，对MMF用量进行个体化调整，有利于预防急性排斥反应和药物毒副反应发生，减少并发症，提高移植肾及受者的存活率。
목적：학정신장이식수자응용매분산지（MMF）적합리치료창농도。방법선취110례신이식수자분별우술후1월내、2~3개월、>4개월응용매방대면역분석기술측정구복MMF（분량차복용，간격12 h）12 h후전혈곡농도（즉MPA-C0），병관찰수자용약기간급성배척반응급약물독부반응발생정황，대소유수자수방시간균위1년。결과통계자료현시，술후급성배척반응발생솔위13.64%（15/110），약물독부반응발생솔위32.73%（36/110），기중백세포감소증12례，MMF상관성복사10례，감염10례，간공능손해4례。발생급성배척반응수자여갑기강적송룡충격치료후균성공역전，약물독부반응수자경치료화（혹）조정MMF제량후병정회복，무사망병례급이식신적제병례。통과ROC곡선계산득출，MPA-C0공제재1.40~2.80 mg/L가교호피면신이식술후급성배척반응병감소수자적약물독부반응。결론대신이식술후복용MMF적수자진행MPA-C0감측，대MMF용량진행개체화조정，유리우예방급성배척반응화약물독부반응발생，감소병발증，제고이식신급수자적존활솔。
Objective To determine the optimal dose range (therapeutic window) of mycophenolate mofetil (MMF) for preventing acute graft rejection following renal transplantation. Methods The trough concentration of MMF (MPA-C0) at 12 h after oral administration of the drug (two doses daily given at an interval of 12 h) was monitored in 110 renal transplant recipients within a month, in 2-3 months, and over 4 months after the transplantation using EMIT method. The occurrence of acute graft rejection and drug toxicity were observed in all the patients during the one-year follow-up. Results The incidence of acute graft rejection after transplantation was 13.64%(15/110) in these patients. Drug toxicity and complications occurred in 32.73%(36/110) of the patients, including 12 cases with reduced white blood cell counts, 10 with MMF cid-associated diarrhea, 10 with infection, 4 with liver function damage. Acute rejection was successfully reversed after methylprednisolone treatment and drug toxicity was managed by corresponding treatment and adjustment of MMF dose. No deaths or graft removal occurred in these patients. The ROC curve showed that a MPA-C0 of 1.40-2.80 mg/L was optimal in preventing acute rejection after the transplantation and reducing adverse drug effects. Conclusion Monitoring MPA-C0 and individualized MMF dosing help to prevent acute graft rejection, reducing drug toxicity and complications, and improving graft survival rate after renal transplantation.