西柚汁增加肝移植术患者他克莫司血药浓度的临床评价

Evaluation and Clinical Significance of Grapefruit Juice on Increasing Tacrolimus Concentration of Liver Transplant Patients

目的评价西柚汁对肝移植患者口服他克莫司谷浓度的影响,探讨西柚汁在肝移植术后抗排异治疗中提高患者他克莫司血药浓度的临床意义。方法对北京大学人民医院肝移植中心的门诊术后患者39例,采用开放、随机、自身对照的方法,干预患者西柚汁和药物服用方法,通过门诊随访收集相应的生理、病理和实验室数据,经统计学分析考察西柚汁对他克莫司稳态血药浓度谷值的影响。同时计算达到相应靶值可能节省的费用。结果在纳入的39例患者中29例为有效病例。西柚汁可明显增加他克莫司稳态谷浓度,平均增加率为(37.1±31.6)%,但并不增加稳态谷浓度的波动性;使血药浓度增加的人群比例为72.4%,平均每人每年可节约的费用约为1.4万元;本试验中疑似西柚汁的不良反应发生率约为10%。结论西柚汁在肝移植术后抗排异治疗中提高大部分患者他克莫司血药浓度有实际的临床意义,但一定要在血药浓度监测条件下,严格遵医嘱进行。

OBJECTIVE To evaluate the effect of grapefruit juice on oral tacrolimus （FK506） trough concentration in liver transplantaion patients, and to investigate the clinical significance of grapefruit juice on increasing drug levels of liver transplantaion patients in anti-rejection therapy. METHODS 39 Post-transplant outpatients in liver transplantation center of People＇s Hospital, Peking University were studied with an open, random, own control method. The administration of grapefruit juice and medicine was interfered. The physiological, pathological and laboratory data were obtained with questionnaire filled in by outpatients, and the influence of grapefruit juice on tarcrolimus steady trough concentration was analyzed with statistical method. Then the saved cost was calculated according to the contribution of grapefruit juice on tacrolimus trough concentration. RESULTS 29 Cases in 39 invdved patients were analyzed. Tacrolimus steady trough concentration was significantly increased with coadministration of grapefruit juice. The mean trough concentration was increased by （37.1±31.6）%. Nevertheless the fluctuation of tacrolimus steady trough concentrations was not augmented. The proportion of patients with increased trough concentrations was 72.4%. The average saving expense person and per year was fourteen thousands RMB; the incidence of adverse reaction of grapefruit juice in the present study was about 10%. CONCLUSION Grapefruit juice can raise tacrolimus trough concentrations of some liver transplantation patients, but the drug concentrations must be monitored, and under supervision of the physician.