环孢素A药物质量浓度监测对患者早期移植肾功能的影响

Influence of cyclosporine pharmacokinetics on the kidney function of recipients at early stage after operation

目的:通过监测环孢素A的血药质量浓度,来判断和调整肾移植术后服用环孢素A(CsA)的有效剂量,为临床减少并发症提供参考。方法:采用免疫荧光偏振TDX法,测定286例肾移植术后受者全血CsA质量浓度,其中164例监测CsA谷值质量浓度(Co组),122例监测CsA峰值质量浓度(C2组)。计算各自的药代动力学参数,分析两组CsA质量浓度测定值与肾移植功能状况及相关临床资料的关系。结果:两组出现急性排斥反应的发生率,Co组明显高于C2组,两组存在显著差异(P>0.05),但两组在药物性肝、肾中毒及肺感染的发生率方面比较均未见显著差异(P<0.05)。结论:对CsA峰值质量浓度进行药代动力学的监测,可以较准确反映肾移植受者的药物剂量,尤其在监控急性排斥反应方面意义较大,同时也可减少CsA肾中毒的危险。

Aim： To explore the clinical effective and safe concentration of cyclosporine （CsA） in kidney transplant recipients. Methods： the CsA blood concentrations in 286 cases were measured by fluorescence polarization immunoassay （TDX） method： 164 cases were monitored Co level （serve as group Co）, 122 cases were monitored C2 level （serve as group C2）. The clinical dates including the incidence rate of renal function after transplant, acute rejection, liver and kidney intoxication of CsA, pneumonia were retrospectively analyzed. Results： The rate of acute rejection in group C2 was apparently lower than in group Co （P 〈 0. 05）, and the rate of liver and kidney intoxication of CsA and pneumonia were no significant difference between group C2 and group Co （P 〉 0. 05）. Conclusion： Pharmacy kinetics monitoring accomplished by multiple point CsA lived samples over the entire 12 h dosing interval is a more accurate assessment for drug exposure. C2 concentration may serve as a effective parameter for CsA dosage adjustment in clinical practice, especially in monitoring acute rejection. Those poor eliminators are at fish to suffer CsAtoxicity.