骨髓移植患者术后环孢素血药浓度监测

Analysis of Results of Therapeutic Drug Monitoring of Cyclosporine A in Patients after Undergoing Bone Marrow Transplantation

目的:探讨异基因骨髓移植患者术后环孢素(CsA)的血药浓度与移植物抗宿主病(GVHD)和药物相关毒性之间的关系。方法:采用荧光偏振免疫分析法(FPIA),对28例骨髓移植患者术后全血谷浓度进行监测,共252例次,并对监测结果进行分析。结果:28例骨髓移植患者252例次监测结果提示,有效浓度为100～400μg.L-1。当浓度>400μg.L-1时,药品不良反应(ADR)发生率增加为16.28%;当浓度<100μg.L-1时,GVHD率增加为27.27%。结论:及时监测CsA浓度,根据动态监测结果制订个体化给药方案,才能减少GVHD以及ADR的发生,提高移植后的成功率。

OBJECTIVE： To evaluate the association of blood concentration of cyclosporin A in patients after undergoing bone marrow transplantation with graft versus host disease（GVHD） and drug-related toxicity.METHODS： Fluorescence polarization immunoassay（FPIA） was applied for determination of the whole blood trough concentrations of CsA in 28 patients after undergoing bone marrow transplantation（totaled 252 times of determination）.Then the monitoring results were analyzed.RESULTS： The monitoring results on 28 cases revealed that the effective concentration of CsA was 100-400 μg ·L-1,and at a concentration of greater than 400 μg·L-1,the incidence of adverse drug reactions（ADR） increased to 16.28%,and at a concentration of lower than 100 μg·L-1,the incidence of GVHD increased to 27.27%.CONCLUSION： Timely monitoring of plasma concentration of CsA and making individualized dosage regimen based on the dynamic monitoring results contributed to lower incidence of GVHD and ADR and higher successful rate following renal transplantation.