他可莫司对肝移植受者外周血T淋巴细胞亚群的影响及临床意义

The effect of Tacrolimus on T-Lymphocyte subsets in liver transplant recipients and its clinical implication

目的探讨他可莫司对肝移植后受者外周血T淋巴细胞亚型的影响及临床意义。方法采用微粒子酶免疫分析法进行他可莫司全血谷浓度测定,监测16例肝移植受者在第1周、第2周、第1个月-第4个月及第6个月的血药浓度。全血样本同时用血细胞分析仪测定血常规,流式细胞仪检测外周血T淋巴细胞亚群。结果他可莫司平均血药浓度基本在推荐治疗窗范围内。他可莫司显著减少肝移植受者外周血CD3+CD4+CD8-细胞百分比,但减少的程度并不受他可莫司血药浓度影响。接受他可莫司治疗后,肝移植早期受者外周血淋巴细胞总数和CD3+T淋巴细胞的绝对计数都显著减少。结论他可莫司主要抑制肝移植受者CD3+CD4+CD8-T淋巴细胞亚群,但其全血谷浓度并不反应T淋巴细胞亚群受影响的程度。提示应在肝移植早期监测他可莫司全血谷浓度和血常规及T淋巴细胞亚群的三项组合检验,为实施个体化检验和临床用药治疗方案调整提供方便和帮助。

Objective To explore the effect of Taerolimus on peripheral blood T-lymphocyte subests in liver transplant recipients.Methods The whole blood Tacrolimus trough levels were measured using micro-particle enzyme immunoassay（MEIA）to monitor the whole blood concentration of 16 cases liver transplant recipients in the first week, second week, first month, second month, third month,fourth month and sixth month.Meanwhile,the whole blood samples were selected to assay the full blood count and the white blood cell count via hematology analyzer and to detect the peripheral blood T-Lymphocyte subsets by flow eytometer.Results The average whole blood Tacrolimus trough levels were generally maintained in the range of the required ideal treatment trough blood concentration. T aemlimus reduced signifieandy the proportion of CD3^ ＋ CD4^ ＋ CD8^-T-Lymphoeytes in the peripheral blood, however, the magnitude of reduction was not influenced by the blood Taerolimus trough level. The Tacrolimus treated patients in the early phase had a decreased in the lymphecytes quantity and absolute numbers CD3^ ＋ T-Lymphoeytes. Conclsion Taerolimus inhibited mainly CD3^ ＋ CD4^ ＋ CD8^-T-lymphecyte subset,however, the whole blood Tacrolimus trough level does not necessarily need to reflected the suppressed number of T-lymphocyte subsets. The study suggested that the liver transplant recipients in the early phase should be carried out in monitoring of three combined assay of the whole blood Tacrolimus trough level, the full blood count and the white blood cell count and T-lymphocyte subsets to provide support for individual assay and the clinical reasonable adjustment of treatment procedures.