存活3年以上肾移植患者环孢素血药浓度监测结果的临床分析

Analysis of Blood Concentration Monitoring Result for Cyclosporin A in Renal Transplant Recipients Surviving for more than Three Years

目的对存活3年以上肾移植患者环孢素(CsA)血药浓度监测的结果进行统计分析,分析术后患者环孢素用药剂量、血药浓度的个体差异,与性别、年龄的关系,评价新三联治疗方案是否可降低环孢素用量及血药浓度,并分析术后时间与ρ2及ρ0的关系。方法采用荧光偏振免疫法(FPIA)测定97例肾移植患者1 780例次环孢素血药浓度,分析术后时间、性别、患者年龄、免疫抑制方案等因素与环孢素血药浓度的关系。结果患者进行肾移植术后,环孢素用药剂量、血药浓度随术后时间的延长而逐渐降低,且个体差异较大。在术后早期,女性患者的用药剂量稍大于男性。随着术后时间的延长,女性患者的用药剂量略低于男性患者,但两者无显著性差异。在用药剂量相似的情况下,女性患者环孢素血药浓度低于男性患者,尤其是术后24个月以后,男女两组血药浓度相比具有显著性差异(P<0.05)。随着年龄的增长,2组患者的用药剂量及血药浓度呈下降趋势;在术后同一时间段内,50岁以上患者环孢素用药剂量及血药浓度低于50岁以下患者,差异有统计学意义(P<0.05)。与老三联治疗方案组相比,新三联治疗方案组中环孢素用量明显减少,血药浓度值降低,呈明显统计学意义(P<0.05)。患者ρ2及ρ0随着移植时间延长及环孢素用量的减少而下降。结论肾移植术后患者的环孢素用药剂量、血药浓度有较大的个体差异。应结合患者的临床表现作用进行全面分析,及时调整治疗方案,实现个性化用药,使环孢素在肾移植后的应用得到最佳治疗效果。

OBJECTIVE To analyze the results of blood concentration monitoring for cyclosporin A （CsA） in renal transplant recipients who have survived for more than three years, thus to investigate the relationship between CsA dose, blood concentration interindividual variability and gender and age, and to determine the possibility of decrease CsA dose and blood concentration by new triple therapeutic protocol, and to analyses the relationship between postoperation time and p2 and P0- METHODS The blood concentrations of CsA of 97 patients （ 1 780 cases ） were determined by FPIA method. The relationships between time after surgery, gender, age, immunosuppressive strategy and blood concentration of CsA were analyzed. RESULTS The blood concentration and dose of CsA decreased with time after surgery, with significant inter-individual difference. The doses for female patients were larger than those for males in the early days after surgery, and then became smaller than male in later time, with no statistical significant difference. Under similar doses, the blood concentrations of CsA in females were lower than those in nlales, but with no significant difference. Twentyfour months after transplantation, significant difference of blood concentration was revealed between female and male patients （ P 〈 0. 05）. With increasing age, the dose and blood concentration decreased in the two groups. The dose and blood concentration of CsA in patients elder than fifty years were lower than those in patients younger than fifty years in the same period after surgery. Compared with the old triple therapeutic protocol group, the dose of CsA and blood concentration decreased in the new triple therapeutic protocol group with significant difference. The P2 and P0 decreased following the time after operation with reduction of CsA dose. CONCLUSION Significant individual difference exists in the dose and blood concentration of CsA in patients after renal transplantation. Multianalysis of the clinical feature of patients should be performed to adjust the therapeutic protocols, thus to achieve personalized pharmacotherapy and the best treatment results.