钙通道阻滞剂对他克莫司血浓度的影响及临床意义

Effect of calcium antagonists on the blood concentration of Prograf and clinical implication

目的 探讨钙通道阻滞剂 (CA)对免疫抑制剂他克莫司 (FK50 6)血浓度的影响。方法 (1 )将 2 0例肾移植患者平均分为 2组 ,观察组除服用FK50 6外 ,还同时服用钙拮抗剂维拉帕米 ;对照组不服用钙拮抗剂。分别检测并比较两组的FK50 6血浓度变化及其量化关系。 (2 )检测 1 0例肾移植患者服用钙拮抗剂维拉帕米前、后自身FK50 6血浓度变化及量化关系。结果 (1 )观察组术后第 1 5d时的FK50 6血浓度为 (1 5 .8± 1 .3) μg/L ,对照组为 (1 0 .2± 1 .7) μg/L ,观察组比对照组平均升高 54 .9% ,P <0 .0 1 ;根据血浓度调整观察组术后不同时间内FK50 6服用量 ,比对照组平均减少2 7.1 %～ 50 .0 %。 (2 )观察组 1 0例肾移植患者加用维拉帕米前FK50 6用量为 (0 .0 6± 0 .0 2 )mg·kg- 1 ·d- 1 ,血药浓度为 (9.2± 1 .8) μg/L ,加用维拉帕米 1w后 ,FK50 6血浓度升至 (1 4 .1± 2 .9) μg/L ,其浓度平均升高了 53 .3 % ,此时调整FK50 6用量减少了 (0 .0 2± 0 .0 1 )mg·kg- 1 ·d- 1 ,减少幅度平均达 33 .3 %。结论 维拉帕米能提高肾移植患者FK50 6的血浓度 ,减少术后FK50 6的服用量 。

Objective To investigate the clinical influence of calcium antagonists (CA) on the blood concentration of Prograf (FK506). Methods After kidney transplantation, the blood concentration of Prograf in 20 cases taking Prograf was monitored. The changes of the blood concentration of Prograf were compared in the patients taking CA with those not taking CA. In 10 cases of kidney transplantation taking Prograf, the changes of the blood concentration of Prograf were compared before and after the patients took Isoptin. Results The blood concentration of Prograf in the observation was ( 15.8 ± 1.3 )?μg/L, being increased by 54.9% as compared with that in the control group ( 10.2 ± 1.7 )?μg/L, P < 0.01 . According to the blood concentration, Prograf dosages adjusted at different time points in the observation was decreased by 27.3% ～ 50.0% averagely. The dosage of Prograf before 10 cases of renal transplantation took Isoptin was ( 0.06 ± 0.02 )?mg/kg every day and the blood concentration was ( 9.2 ± 1.8 )?μg/L. After administration of Isoptin for one week, the blood concentration of Prograf was increased to ( 14.1 ± 2.9 )?μg/L, averagely being increased by 53.3% , and the dosage of Prograf averagely decreased by ( 0.02 ± 0.01 )?mg/kg every day ( 33.3 % ).Conclusion After kidney transplantation, the blood concentration of Prograf in the patients taking Prograf with Isoptin is increased significantly and the treatment dosage of Prograf reduced.