环孢菌素A血浓度监测对神经系统自身免疫性疾病治疗的意义

Clinical Significance of Monitoring Cyclosporine A Serum Level in the Treatment of Neurological Autoimmune Diseases

目的 评价环孢菌素 A(cyclosporine,Cs A)血浓度监测的临床意义及其对治疗神经系统自身免疫性疾病〔重症肌无力 (MG)和多发性硬化 (MS)〕的安全性。方法 MG2 6例和 MS8例主要用肾上腺皮质激素 +Cs A治疗。Cs A全血浓度测定采用单克隆抗体荧光偏振免疫分析法 (Mc Ab-FPIA) ,Cs A安全性的评价用定期监测肝、肾功能 ,血糖及血、尿常规指标和记录患者出现的不良反应。结果 (1 )肾上腺皮质激素冲击 +Cs A治疗 MG和MS的有效率分别达 77.78% (2 1 /2 7)和 87.50 % ;(2 )服用 Cs A治疗 1个月内 ,其副作用出现率较高 ,主要以肾功能异常为常见 (占 4 7.1 % ) ,多以尿素氮升高为主 ;(3 )应用 Cs A后较常见的副作用是头晕、恶心及心慌。 (4 )Cs A血浓度变化个体差异很大 ,但同一个体比较其中毒浓度明显高于非中毒浓度。结论 Cs A治疗神经系统自身免疫性疾病有效、安全。服用 Cs A后一定要监测其血药浓度 ,开始用药 1个月内每周定期复查肝、肾功能 ,结合临床病情及时调整剂量 。

Objective To evaluate the clinical significance of monitoring cyclosporine A serum level and its safety in the treatment of neurological autoimmune disease (myasthenia gravis and multiple sclerosis). Methods The principal strategy of treatment for myasthenia gravis (26 cases) and multiple sclerosis (8 cases) was intensive adrenal corticosteroid treatment(IACST)plus CsA.The serum level of CsA was monitored by McAb FPIA. The safety of CsA was evaluated by testing hepatic and renal function, fasting blood glucose, and urine routines regularly and recording the adverse responses. Results (1) The therapeutic effect of IACST plus CsA for myasthenia gravis was 77 78% and for multiple sclerosis was 87 50%. (2) The side effect of CsA were mainly occured within one month after administrating it, and the more frequent, 47 10%, was nephrotoxicity (increased blood urea nitrogen and creatinine). (3) The most common adverse reactions were dizziness, nausea, palpitation etc. (4) The serum levels of CsA among individuals were quite different, but the toxic serum of CsA was significantly higher than nontoxic ones individually.Conclusions CsA treatment was effective and safe in the treatment of neurological autoimmune diseases. The treatment should be individualized according to serial determination of hepatic and liver function regularly, especially within the first month of treatment, and thedose should be adjusted according to patient condition and the serum level of CsA.