他克莫司血药浓度监测在异基因干细胞移植患者中的应用

Medication Analysis of Therapeutic Drug Monitoring for Tacrolimus in Allogeneic Hematopoietic Stem Cell Transplantation

目的：探讨异基因外周血干细胞移植（Allo-HSCT）患者他克莫司血药浓度监测结果与疗效、毒副反应及联合用药等的相关性,为他克莫司临床合理应用提供参考。方法：采用酶扩大免疫分析法对16例Allo-HSCT患者住院期间Allo-HSCT 3个月后他克莫司血药浓度进行监测,对移植物抗宿主病（GVHD）出现的情况、不良反应、联合用药情况加以分析讨论。结果：他克莫司血药浓度个体差异较大。当〈8 ng/ml时,GVHD发生几率增加;〉20 ng/ml时,患者出现糖尿、肾脏毒性等不良反应的几率增加。他克莫司对于预防和治疗GVHD的作用较好,与其他药物联用可产生相互作用。结论：他克莫司血药浓度监测在Allo-HSCT患者术后预防和治疗GVHD及减少毒副反应方面有重要的作用。Allo-HSCT 3个月后,其血药浓度维持在8~20 ng/ml之间,GVHD和不良反应出现的几率较小。

OBJECTIVE：To investigate blood concentration monitoring data,therapeutic efficacy,toxic reaction and combination of tacrolimus in patients with Allo-HSCT,and to provide reference for clinical application of tacrolimus. METHODS：The blood concentration of tacrolimus in 16 inpatients were monitored with EMIT 3 months after Allo-HSCT. The occurrence of Graft-versus-Host disease（GVHD）,ADR and drug combination were analyzed and discussed. RESULTS：A large individual differences were found in blood concentration of tacrolimus. When blood concentration 8 ng/ml,there seems a greater possibility of GVHD. When 20 ng/ml,the occurrence of diabetes,kidney damage and other side effects seems increased. Tacrolimus had a good effect on treatment and prevention of GVHD,and could have an interaction with other drugs. CONCLUSIONS：Blood concentration monitoring of tacrolimus plays an important role on the prevention and treatment of GVHD,and the decrease of side effects such as diabetes and neurotoxicity. The satisfactory blood concentration is 8-20 ng/ml,when there seems a smaller possibility of GVHD and ADR 3 months after Allo-HSCT.