环孢素A血浓度监测在异基因骨髓移植中的意义

The role of cyclosporine A concentration monitoring in marrow heterologous transplantation

观察６９例异基因骨髓移植患者，探讨环孢素Ａ（ＣｓＡ）谷浓度与急性移植物抗宿主病（ａＧＶＨＤ）和ＣｓＡ相关毒副作用之间的关系。结果表明，Ⅱ～Ⅳ度ａＧＶＨＤ发生率为３６．２３％；Ⅱ～Ⅳ度ａＧＶＨＤ的发生与植活时的ＣｓＡ谷浓度相关（Ｐ＝０．０３１８）；若谷浓度低于１５０μｇ／Ｌ，Ⅱ～Ⅳ度ａＧＶＨＤ发生率增加（Ｐ＜０．０５）；当ＣｓＡ谷浓度高于２００μｇ／Ｌ时，ＣｓＡ相关的肝、肾毒副作用发生率明显上升（Ｐ＜０．０５）。认为将ＣｓＡ谷浓度尤其是植活时的谷浓度维持在１５０～２００μｇ／Ｌ，可以提高ＣｓＡ的效果，并降低ＣｓＡ的肝、肾毒副作用发生率。

Sixty-nine patients undergoing heterologous transplantation were retrospectively analyzed to investigate the relationship between toxicity and adverse effects of cyclosporine A (CsA) and acute graft versus host disease (GVHD). The results showed that the incidence of acute GVHD with Ⅱ￣Ⅳ grade ( 36.23% ) was related to the trough concentration of CsA ( P = 0.031 8 ). The incidence of acute GVHD with Ⅱ￣Ⅳ grade increased with the CsA trough concentration less than 150μg/L. The incidence of toxicity and adverse effects on liver and kidney was obviously increased with the CsA trough concentration over 200μg/L( P < 0.05 ). It was suggested that the optimal trough concentration of CsA was 150￣200μg/L, which might improve the therapeutic effects of CsA and reduce the incidence of toxicity and adverse effects on liver and kidney.