肾移植受者合理使用糖皮质激素类药物初探

Study of rational utilization of glucocorticoid in renal allograft recipients

对７２例７５例次肾移植受者术前、术后的内、外源性糖皮质激素（ＧＣ）血中浓度进行了动态监测，结果表明肾移植受者血中ＧＣ谷浓度与剂量无明显的正相关（Ｐ＞０．０５）；肾上腺ＧＣ类药物剂量与肾上腺皮质分泌功能的负相关亦无统计学意义（Ｐ＞０．０５）；外源性ＧＣ血药浓度对肾上腺皮质内分泌功能的抑制为具有统计学意义的负相关（Ｐ＜０．０５）。提示对于肾上腺皮质激素类药物使用的量化指标，应根据外源性ＧＣ的谷、峰浓度以及内源性ＧＣ变化情况进行分析。由于ＧＣ药物的药效动力学及药物动力学差异的存在，故内源性ＧＣ的变化较外源性浓度更能客观反应出外源性ＧＣ的药效。在肾移植受者使用ＧＣ时，受者肾上腺皮质残余率维持在６．２％±４．１％范围内，既可达到有效的免疫抑制，又可避免因剂量过大所导致的感染。

Abstract Serum glucocorticoid level (GC level) included endoguous GC(Hydrocortisone HC)and exogeuous GC (Dexamethasone,Predisone and Methylprednisolone) were measured by high-performence liquid chromatography(HPLC) in 72 cases (75 times of transplantation) of allo transplantation. There was no positive correlation between the blood trough level of exogeuous GC and the dosage of glucocorticoid agents (P>0.05); There was no positive correlation between the dosage of glucocorticoid agent and the endogeuous GC level or adrenalcortical function residual rate (P>0.05).There was negative correlation between the blood GC concentration trough level and endogeuous GC level or adrenalcortical function residual rate (P<0.05). The results of our investigation suggested for reasonable use of glucocorticoid the blood peak level and trough level of them as well as the blood endgeuous GC level and adrenal function residual rate should be measured. Our results showed that when the bordline value of adrenal function residual rate was 6.2%±4.1%, It had effective immunosuppressive and could avoid infection. The dosage of GC might be negative regulate by the bordline value of blood endogeuous GC level and adrenal function residual rate.