心脏移植术后环孢素A血药浓度监测与临床疗效关系的研究

Relationship between Concentration of Cyclosporine A and Its Clinical Efficacy after Heart Transplant

目的研究心脏移植患者术后环孢素A血药浓度与临床疗效之间的关系,提高患者用药的有效性和安全性。方法回顾性分析27例心脏移植受者458例次血药浓度监测结果,将心脏移植患者分为3组:正常组、毒性组、排斥组,统计各组间血药浓度的差异,并以是否发生排斥反应及毒性反应分组讨论术后不同时期在患者发生急性排斥反应或药物毒性时血药浓度的变化。结果术后初期体内环孢素A血药浓度变化趋势具有不可预测性;正常组与毒性组、排斥组间平均谷浓度(ρ0)和峰浓度(ρ2)比较均有显著性差异;毒性组与非毒性组间、排斥组与非排斥组间的ρ0在心脏移植术后多数时间段比较均无显著性差异,而ρ2在术后多数时间段各组间比较均有显著性差异,且ρ2能够预测吸收不良的病例,表明监测ρ2比ρ0更具临床价值。结论环孢素A血药浓度监测可以指导临床合理用药,以ρ2为监测点能更有效地预防急性排斥反应、毒性反应及调整给药剂量,比ρ0更具有科学性和敏感性,同时应结合患者的临床表现,实施个体化用药方案,使心脏移植术后患者能获得满意的免疫抑制治疗效果。

OBJECTIVE To improve the efficacy and safety of cyclosporine A through analysis of the relationship between drug monitoring data and its clinical efficacy after heart transplant （HT）. METHODS Four hundred and fifty-eight blood concentration data from 27 HT patients were retrospectively analyzed. The HT patients were divided into normal, toxic, and rejection group. The cy- closporine A blood concentrations among these three groups were compared. The changes of blood concentrations were discussed in dif- ferent postoperative periods of HT patients grouped by the occurrence of rejection and toxicity respectively. RESULTS The trend of cyelosporine A blood concentration change was unpredictable in the early postoperative period. The average P0 and P2 had significant differences among the three groups. P0 had no significant difference in most postoperative periods between toxic group and non-toxic group or rejection group and non-rejection group, however,p2 had a significant difference in most postoperative periods and P2 was also able to predict the cases of malabsorption, indicating that monitoring P2 had more clinical significance than monitoring P0- CONCLU- SION Blood concentration monitoring can provide a reference for eyclosporine A usage in the clinical practice. For HT patients,p2 is more scientific and sensitive than P0 as a monitoring index in both preventing acute rejection and toxicity and adjusting dosage. Cyclos- porine A blood concentration monitoring should be closely combined with clinical practice to individualize its use and thus achieve a sat- isfactory immunosuppressive effect.