肾移植术后患者血液他克莫司代谢率(C0/D值)对肝肾功能的影响研究

Metabolic Rate of Tacrolimus(C0/D ratio)and the Effects on Hepatic Function Renal Function after Renal Transplantation

目的探讨肾移植患者体内他克莫司(Tac)代谢率(C0/D值)和肝肾功能、血浆蛋白的关系,以期对临床的合理用药提供依据。方法收集211例肾移植术后12个月以上并服用他克莫司的血液标本,化学发光免疫法检测血Tac浓度;酶法测定TBIL,DBIL,ALT,AST,Urea,Cr,UA,CO2,TP和ALB;全自动血液分析仪检测HGB。根据C0/D值从小到大排列并平均分组,将肾移植受者分为快代谢、中间代谢和慢代谢三组。通过比较三个代谢组的肝、肾功能以及血浆蛋白水平,探讨Tac的代谢率对肾移植受者的肝、肾功能的影响。结果肾移植患者ALT,Urea,Cr,eGFR,CO2,ALB和HGB水平在不同Tac代谢组之间,差异均有统计学意义(F=3.311~6.382,均P<0.05),而TBIL,DBIL,AST,UA和TP水平在不同代谢组之间差异无统计学意义(F=0.9~2.379,均P>0.05)。结论在血药浓度控制相对稳定的情况下,肾移植术后患者血液他克莫司代谢率(C0/D值)影响体内ALT,Urea,Cr,eGFR,CO2,ALB和HGB的水平,而对TBIL,DBIL,IBIL,UA和TP的影响不大。

Objective To investigate the relationship between the C0/D ratio(blood trough concentration/dosage)and the hepatic function renal function and plasma protein levels after renal transplantation in order to guide the reasonable follow-up treatment.Methods 211 cases and blood samples were collected who took kidney transplantation operation after 12 month and took Tac after operation.The Tac were detected by the method of chemiluminescent immunoassay.TBIL,DBIL,ALT,AST,Urea,Cr,UA,CO2,TP and ALB were detected by the Enzymatic method,and HGB were detected by Automatic blood analyzer.The C0/D ratio were ranked from small to large and were divided into three groups equally.Renal recipients were divided into three groups:rapid metabolism,intermediate metabolism and poor metabolism groups.To investigate weather metabolic rate of the Tac was the key factor to affect the hepatic and renal function of the renal transplant recipients through comparing the hepatic and renal function and plasma protein level among there metabolic groups.Results There were significant differences in ALT,Urea,Cr,CO2,ALB and HGB levels among different metabolic groups of Tac in renal transplantation patients(F=3.311~6.382,all P<0.05),but there were no significant difference in TBIL,DBIL,AST,UA and TP levels(F=0.9~2.379,all P>0.05).Conclusion Under the condition of relatively stable blood concentration control,the C0/D ratio of the Tac in the renal transplantation would affect the levels of ALT,Urea,Cr,eGFR,CO2,ALB and HGB,but little effects on the levels of TBIL,DBIL,IBIL,UA and TP.