肾移植术后配伍他克莫司时血霉酚酸浓度测定的有限检样法研究

Evaluation of mycophenolic acid exposure by limited sampling strategy in Chinese adult renal transplant recipients receiving mycophenolate mofeil and tacrolimus

目的 研究成人肾移植术后霉酚酸的药代动力学特点,建立配伍他克莫司的血霉酚酸浓度曲线下面积的有限检样方法.方法 42例成人肾移植受者,采用吗替麦考酚酯（MMF）联合他克莫司、泼尼松的三联免疫抑制方案.血霉酚酸浓度通过高效液相色谱法测定,采血点为服药前（C0）及服药后0.5、1、1.5、2、3、4、6、9和12h,用梯形面积法计算浓度曲线下面积,采用多元线性回归分析,确定相关采血点,确定有限取样方案.结果 通过多元线性回归分析得出3点估算MPA-AUC=7.297＋2.819C1.5 h＋3.297C4h＋4.269C9 h[相关系数（r2）=0.878],4点估算的MPA- AUC=2.519＋0.549C0.5 h＋1.900C1.5 h＋3.931C4h＋4.037C9 h（r2=0.928）.采用Bland ＆ Altman分析法评估,3点法和4点法均未超出置信限范围,二者与全点AUG0-12h有较好的一致性.3点评估AUC与全点AUG0-12h差值为（11.7±8.32）mg·h·L-1,二者差值的95％置信区间为9.18～14.37 mg·h·L-1 （P＜0.01）；4点评估AUC与全点AUG0-12h差值为（1.65±7.98）mg·h·L-1,二者差值的95％置信区间为-0.84～4.13 mg·h·L-1 （P＜0.01）.结论 该有限检样方案适用于监测成人肾移植受者配伍他克莫司用药时血霉酚酸浓度的曲线下面积.

Objective To investigate the pharmacokinetics of mycophenolic acid （MPA） in Chinese adult renal allograft recipients,and to generate the validated model equations for estimation of the MPA area under the plasma concentration-time curve from 0 to 12 h （AUC0-12h） with a limitedsampling strategy.Methods The pharmacokinetics in 42 Chinese renal allograft recipients treated with mycophenolate mofetil in combination with tacrolimus and corticosteroids were determined. MPA concentration was assayed by high-performance liquid chromatography （HPLC） at pre-dose （G0） and at 0.5（G0.5h）,1 （C1h）,1.5 （C1.5h）,2 （C2h）,3（C3h）,4 （C4h）,6 （C6h）,9 （C9h） and 12 （C12h） h,respectively.The modd equations were generated by multiple stepwise regression analysis for estimation of the MPA-AUC by a limited sampling strategy.Results The prediction formulas were as follows：MPA-AUC1.5 h-4h-9 h =7.297 ＋ 2.819C1.5 h ＋ 3.297C4 h ＋ 4.269C9 h （ r2 =0.878） ; and MPA-AUG0.5 h-1.5 h-4 h-9 h =2.519 ＋ 0.549G0.5 h ＋ 1.900 C1.5 h ＋ 3.931 C4 h ＋ 4.037C9 h （r2 =0.928）.We plotted the average of estimated AUC and full MPA-AUC0-12 h.The Bland 8 Altman analysis indicated good agreement to within 1.96SD.Mean difference of the prediction formula using the three time points of C1.5 h-C4 h-C9 h was （11.7 ± 8.32） mg·h·L-1 and 95% confidence interval （CI） was （9.18～14.37） mg·h·L-1,p〈0.01 ; mean difference of the prediction formula using the four time points of G0.5 h-C1.5 h C4 h-C9 h was （1.65-±7.98） mg·h·L-1,and 95% CI （-0.84～4.13） mg·h·L-1,P〈0.01.Conclusion This limited sampling strategy provides an effective approach for estimation of full MPA AUC0-12 h in Chinese adult renal allograft recipients treated with mycophenolate mofetil in combination with tacrolimus in the stable post transplant period.