维吾尔族肾病综合征患儿他克莫司全血谷浓度监测分析

Monitoring the blood trough concentration of tacrolimus in the treatment of Uygur children with nephrotic syndrome

目的监测维吾尔族原发性肾病综合征（PNS）患儿他克莫司全血谷浓度并分析相关临床数据,以期为维吾尔族PNS患儿个体化应用他克莫司提供依据。方法对接受他克莫司治疗的70例维吾尔族PNS患儿的血药浓度、生化检验指标及合并用药进行回顾性调查分析,探讨他克莫司全血谷浓度与临床疗效的相关性,根据临床疗效分为完全缓解组（CR组）、部分缓解组（PR组）、未缓解组（NR组）。结果CR组剂量标准化谷浓度为（2.95±1.17）ng/mL/[mg/（kg·d）]、PR组剂量标准化谷浓度为（4.22±2.92）ng/mL/[mg/（kg·d）]、NR组剂量标准化谷浓度为（1.72±1.43）ng/mL/[mg/（kg·d）],三组比较差异有统计学意义（P〈0.05）,但三组给药剂量差异无统计学意义（P〉0.05）。他克莫司治疗维吾尔族PNS患儿的缓解率为75.71%。结论他克莫司全血谷浓度与药物剂量及相关药物代谢基因相关,在全血谷浓度达5~10 ng/mL时,可达到满意的治疗效果。

Objective To monitor the tacrolimus blood concentration in the treatment of Uygur children with nephrotic syndrome and to analyze the related clinical data in order to provide evidence for individualized application of tacrolimus in PNS patients.Methods The blood drug concentration,biochemical indexes and combined medication of 70 patients with PNS were retrospectively analyzed,and the relationship between tacrolimus blood concentration and clinical efficacy was evaluated.According to the clinical curative effect,patients were divided into complete remission group（group CR）,partial remission group（group PR）,and no remission group（group NR）.Results The dose normalized trough concentration of group CR,group PR and group NR was（2.95 ± 1.17）ng/mL/[mg/（kg·d）],（4.22 ± 2.92）ng/mL/[mg/（kg·d）]and（1.72 ± 1.43）ng/mL/[mg/（kg·d）]respectively,there being significant difference among the three groups（P〈0.05）,but there was no significant difference on dose among the three groups（P〈0.05）.The remission rate was 75.71%.Conclusion The blood concentration of tacrolimus in the treatment of nephrotic syndrome is correlated to the dose of tacrolimus and genetic polymorphism,and it can achieve satisfactory therapeutic efficacy on nephrotic syndrome patients in the range of 5 ~ 10 ng/mL of tacrolimus blood concentration.