肾病综合征患者个体化应用他克莫司的病例分析

Case analysis of individualized tacrolimus treatment on patient with nephrotic syndrome

目的结合基因型检测及治疗药物监测,为患者提供合理的治疗方案。方法临床药师通过参与1例儿童肾病综合征患者的治疗过程,分析住院前期药效不佳的原因,结合他克莫司基因检测结果,提示临床医师调整适宜给药剂量,或通过合并用药的方式提升血药浓度。建议监测他克莫司的血药浓度,合理使用免疫抑制药。结果与结论患者他克莫司浓度迅速达标且病情好转出院。在临床上,可结合患者疾病、用药、基因型等因素,结合利用药物相互作用提升他克莫司血药浓度,节省患者开支,并充分运用治疗药物监测等手段,提高药物治疗的有效性和安全性。

Objective To combine genotyping and therapeutic drug mo- nitoring （TDM） and to provide patients with reasonable treatment. Methods Clinical pharmacists were able to participate in the treatment of 1 patient with nephrotic syndrome, analyze the causes of poor efficacy in the early stage of hospitalization, combine the genotyping result and remind the clinicians to adapt an appropriate drug dose, or use a combi- nation of drugs to improve drug plasma concentration. It is recommended to monitor the plasma drug concentration of tacrolimus and develop ration- al use of immunosuppressant drugs. Results and conclusion The pa- tient＇ s tacrolimus concentration quickly reached the standard and his condition improved. The patient was discharged. In clinical practice, pharmacists should combine the patient＇s diseases, medications, geno- types and other factors, with the use of drug interactions to increase plasma concentration of tacrolimus, save the patient＇s expenses, and fully use therapeutic drug monitoring and other means to improve the effectiveness of drug treatment and safety.