肾病综合征患者他克莫司血药浓度影响因素分析

Analysis of influence factors on tacrolimus concentration in patients with nephrotic syndrome

目的分析他克莫司血药浓度监测结果,探讨他克莫司血药浓度影响因素。方法回顾性收集2015年8月至2016年7月于我院用他克莫司治疗的肾病综合征患者114例,记录用药情况,分析年龄、性别、肝肾功指标、合并用药等与他克莫司血药浓度的相关性。结果血药浓度在有效范围内的患者占48.25%;女性给药剂量显著高于男性(P<0.05),而标准化血药浓度显著低于男性(P<0.05);不同浓度组间合用五酯片比例差异有统计学意义(P<0.05)。结论性别及合用五酯片能够显著影响他克莫司血药浓度。临床医师和药师应遵循个体化用药原则,根据血药浓度的影响因素制定和调整他克莫司用药方案。

Objective To investigate influence factors of tacrolimus blood concentration,and provide reference for the clinical use of tacrolimus by analyzing tacrolimus blood concentrationin patients with nephrotic syndrome. Methods Data of tacrolimus usage were retrospectively collected from August 2015 to July 2016 in 114 patients with nephrotic syndrome in our hospital. Association of dose,age,sex,drug combination,blood routine index,hepatic and kidney function index with tacrolimus blood concentrations were analyzed. Results Tacrolimus concentration in the effective range of patients was 48. 25%. Dose of female group was significantly higher than that in male group（ P〈0. 05）,while dose-adjusted concentration of female group was significantly lower than that of male group（ P〈0. 05）. There was significant difference in the proportion of combined Wuzhi tablet among different concentration groups（ P〈0. 05）. Conclusion Sex and combination with Wuzhi tablet could significantly affect tacrolimus concentration. Physicians and clinical pharmacists should follow the principle of individualized medicine,formulate and adjust drug regimen according to the influence factors of tacrolimus concentration.