肾移植术后环孢素A血药浓度C_2监测

Clinical value of C_2 monitoring for renal function in stable renal transplant recipients

目的：探讨术后存活期1a以上的肾移植患者C2（服用环孢素（CsA）2h后的血药浓度）监测的临床效果。方法：术后存活期1a以上、接受微乳化CsA（6～8mg／（kg·d））、硫唑嘌呤和泼尼松三联免疫抑制治疗的患者75例，采用荧光偏振免疫方法进行CsA全血药浓度测定。C2监测至少6个月，CsA治疗窗浓度范围定为（900±120）μg／L。结果：C2监测前，46例（61％）患者CsA全血浓度高于目标浓度范围，13例（17％）低于目标浓度范围。C2监测6个月后，与C2监测前比较患者的尿素氮降低（P〈0．05），而血清肌酐、胆固醇和甘油三酯水平差异无统计学意义（P〉0．05）；CsA平均剂量从（241±63）mg减至（213±50）mg（P〈0．05），每人每年节省费用约3500元；C2监测6个月后，CsA暴露量过高患者组的BUN水平较监测前降低（P〈0．05）。结论：稳定期肾移植患者实行C2监测安全、有效。这种方法有利于肾功能的改善并有助于减少药品费用。

Aim ： To evaluate the clinical value of C2 （2-hour post-absorption lcvelsof CsA） monitoring in long-term renal transplant patients （ 〉 12 months）. Methods： A total of 75 kidney transplant patients receiving CsA, steroids, and azathioprine were switched to C2 monitoring, seeking to achieve a target range of （900±120） μg/L. The patients were monitored for at least 6 months. Results： Before the monitoring, the C2 values of 46 patients （61%） were above and 13 patients （17%） below the therapeutic range. Six months after the monitoring, creatinine（Cr） , cholesterol, and triglyceride levels were unchanged, Mean CsA dose was decreased by 10% from （241±63） mg to （213±50） mg （P 〈0.05） , implying a savings of 3 400 yuan per patient per year. Among the patients who showed a high C2 level, there was also a reduction in BUN （ P 〈 0.05）. Conclusion ： C2 monitoring in stable kidney transplant recipients is feasible and safe. The strategy results in reduced drug costs and improved renal function.