肝移植患者术后早期应用他克莫司与其凝血功能相关性分析

Analysis of the correlation between early application of tacrolimus and coagulation function in patients after liver transplantation

目的探讨肝移植术后患者早期应用他克莫司抗免疫治疗引起的凝血功能变化及意义。方法回顾性分析2015年9月至2019年10月在我院行原位肝移植术,且术后24 h内均采用他克莫司+吗替麦考酚酯+肾上腺皮质激素三联抗排异方案治疗的71例患者。监测患者术前及术后1~5 d内凝血酶原时间(prothrombin time,PT)、活化部分凝血酶原时间(activeated partial thromboplasting time,APTT)、凝血酶时间(thrombin time,TT)、血小板计数(blood platelet,PLT)以及纤维蛋白原(fibrinogen,FBG)等指标。结果患者的PT、APTT及TT在术后1~2 d内出现短暂上升后下降,并在5 d内逐渐恢复至接近正常值;FBG在术后1 d出现下降,2~5 d内恢复正常后出现下降,术后4~5 d与术前值相比,差异具有统计学差异(P<0.05);PLT在术后1~5 d内呈逐渐下降趋势,其中2~5 d与术前相比差异均具有统计学意义(P<0.05)。结论肝移植患者术后应用治疗量的他克莫司可能会造成血小板的聚集,从而导致PLT减少。临床药师在关注患者他克莫司血药浓度的同时,应警惕患者血小板的变化,以防浓度超过正常范围,诱发血栓性微血管病等严重不良反应。

Objective To investigate the changes and significance of coagulation function caused by early application of anti-immunotherapy regimen of tacrolimus in patients after liver transplantation.Methods A retrospective analysis of 71 patients who underwent allogeneic orthotopic liver transplantation in our hospital from September 2015 to October 2019,using tacrolimus+mycophenolate mofetil+adrenocorticotropic hormone within 24 hours after surgery.The levels of prothrombin time(PT),activeated partial thromboplasting time(APTT),thrombin time(TT),blood platelet(PLT)and fibrinogen(FBG)were measured before surgery and 1~5 d after surgery.Results The levels of PT,APTT and TT showed a short rise within 1~2 d after operation and then decreased,and gradually returned to nearly normal level within 5 days.The level of FBG decreased on the first day after surgery and returned to normal level within 2~5 d.The difference was statistically significant between 4~5 days after operation,comparing with that before operation(P<0.05).The level of PLT showed a gradual downward trend within 1~5 d after surgery,and the differences between 2~5 d and before surgery were statistically significant(P<0.05).Conclusion After liver transplantation,tacrolimus may cause platelet aggregation and the decrease of PLT.Clinical pharmacists should pay attention to the blood concentration of tacrolimus and the changes of platelets to prevent serious adverse reactions such as thrombotic microangiopathy.