CAJ | 학술논문

目的：观察肾移植术后供肾多药耐药基因（MDR1）外显子26及外显子21的基因型对他克莫司（FK506）急慢性肾毒性和血药浓度的影响。方法回顾51例肾移植术后常规使用FK506+MMF+Pred三联免疫抑制用药方案的患者资料。通过基因组测序检测肾移植供者MDR1 exon26和exon21的基因型，比较不同供肾基因型的患者FK506的用量、血药浓度及和肾毒性的差异。结果在术后1年时比较内生肌酐清除率时，在exon26中，TT型的内生肌酐清楚率明显低于CC型和CT型（P<0.05），在exon21中，低表达型（TT型）明显低于高表达型（GG/GT/GA/AT型）（P<0.05）；在比较术后1个月内的移植肾急性肾中毒发生率时，exon21中低表达型明显高于高表达型（P<0.05）。结论在保护移植肾功能，减少FK506的急慢性肾毒性上，exon26的CC/CT型和exon21的高表达型明显优于exon26的的TT型和低表达型。
목적：관찰신이식술후공신다약내약기인（MDR1）외현자26급외현자21적기인형대타극막사（FK506）급만성신독성화혈약농도적영향。방법회고51례신이식술후상규사용FK506+MMF+Pred삼련면역억제용약방안적환자자료。통과기인조측서검측신이식공자MDR1 exon26화exon21적기인형，비교불동공신기인형적환자FK506적용량、혈약농도급화신독성적차이。결과재술후1년시비교내생기항청제솔시，재exon26중，TT형적내생기항청초솔명현저우CC형화CT형（P<0.05），재exon21중，저표체형（TT형）명현저우고표체형（GG/GT/GA/AT형）（P<0.05）；재비교술후1개월내적이식신급성신중독발생솔시，exon21중저표체형명현고우고표체형（P<0.05）。결론재보호이식신공능，감소FK506적급만성신독성상，exon26적CC/CT형화exon21적고표체형명현우우exon26적적TT형화저표체형。
ObjectiveTo explore the significance of kidney MDRl gene polymorphism for taking FK506 in renal transplant recipients. To guide clinicians adjust the tacrolimus dosage in the clinical to reduce the side effects of tacrolimus.MethodsSelect clinical date of 50 patients receiving renal transplantation the first time in our hospital from July 2012 to February 2013 period .Taking FK506+MMF+ Pred triple immunosuppressive regimen after operation and determine their MDR1 genotype. According to clinical date,compare the difference of donor kidney MDR1 exon21 and exon26 on patients with different genotypes the daily dose of FK506 and acute/chronic toxicity to the transplant kidney.ResultsComparing recipients’ Ccr one year after renal transplantation,in MDR1 exon26,TT-type Ccr was significantly lower than CC-type and CT-type(P<0.05),the difference between CC-and CT-type has no statistical significance. In exon21,the Ccr of low expression type(TT type)was significantly lower than the high expression of type (GG/GT/GA/AT-type)Comparing the incidence of acute renal toxicity induced by FK506 in one month after surgery,in MDR1 exon21,the low expression type(TT type)is greater than the expression of type(GG/GT/GA/AT-type)(P<0.05). There is no significant difference(P> 0.05)between MDR1 exon26 genotypes.ConclusionIn the protection of graft function,reduction of acute and chronic renal toxicity of FK506,in MDR1 exon26,the CC / CT type is significantly better than TT type. And in MDR1 exon21,the high-expressed type is significantly better than low-expression type.