心脏移植患者术后早期使用他克莫司对血肌酐水平的影响

Effects of Tacrolimus on Serum Creatinine Levels in Heart Transplantation Recipients in Postoperative Early Stage

目的研究他克莫司对心脏移植患者术后早期血肌酐水平的影响。方法收集2016年11月~2020年12月于我院行心脏移植手术并使用他克莫司的患者病历资料进行回顾性分析。根据血肌酐较术前升高倍数分为升高<1.5倍、1.5~2.0倍、2.0~3.0倍和≥3.0倍或启动透析,根据他克莫司血药谷浓度分为≤15 ng·mL^(-1)和>15 ng·mL^(-1)两组。收集术前和术后1周、1月和3月的血肌酐及他克莫司血药谷浓度值,分析血肌酐变化情况与他克莫司血药浓度的关系。结果纳入分析患者共117例。对比他克莫司血药浓度≤15 ng·mL^(-1)和>15 ng·mL^(-1)两组患者的血肌酐上升(超过基线1.5倍)的发生率,术后1周分别为38例(36.2%)和10例(83.3%),发生率差异有统计学意义(P<0.01),术后1月分别为38例(34.5%)和6例(85.7%),发生率差异有统计学意义(P<0.01),术后3月发生率差异无统计学意义(P>0.05)。术后1周(P<0.01)和术后1月(P<0.01)他克莫司血药浓度>15 ng·mL^(-1)的患者,血肌酐升高的倍数更高,差异具有统计学意义。结论术后1周和术后1月他克莫司血药浓度超出治疗窗的患者血肌酐升高的发生率和升高倍数更高。心脏移植患者术后早期使用他克莫司应定期进行血药浓度监测并根据检测结果及时调整药物剂量,严格控制血药浓度不超过15 ng·mL^(-1)。

OBJECTIVE To investigate the effect of tacrolimus on serum creatinine levels in heart transplantation recipients in postoperative early stage. METHODS The medical records of patients who received heart transplantation and tacrolimus therapy in our hospital from November 2016 to December 2020 were collected for retrospective analysis.According to the fold increase of serum creatinine compared with preoperatively, they were divided into increase <1.5 times, 1.5-2.0 times, 2.0-3.0 times and ≥3.0 times or initiation of dialysis, and according to the trough blood concentration of tacrolimus, they were divided into ≤15 ng·mL^(-1) and >15 ng·mL^(-1) in two groups.The serum creatinine and blood trough concentration of tacrolimus were collected preoperative and postoperative 1 week, 1 month and 3 months.And the relationship between the change of serum creatinine and the blood concentration of tacrolimus was analyzed. RESULTS A total of 117 patients were included in the study.Comparing the incidence of increased blood creatinine(1.5 times more than baseline) in the two groups of patients with tacrolimus blood concentration ≤15 ng·mL^(-1) and >15 ng·mL^(-1),at postoperative 1 week there were 38 cases(36.2%) and 10(83.3%) cases respectively, which was statistically different(P<0.01).And at postoperative 1 month there were 38 cases(34.5%) and 6 cases(85.7%) respectively, and the incidence was also statistically different(P<0.01).There was no significant difference in the incidence at postoperative 3 months(P>0.05).Patients whose blood concentration of tacrolimus>15 ng·mL^(-1) at postoperative 1 week 1(P<0.01) and 1 month(P<0.01) had a higher fold increase in serum creatinine, which were statistically different. CONCLUSION Patients whose blood concentration of tacrolimus exceeds the treatment window at postoperative 1 week and 1 month have a higher incidence and multiples of increase in serum creatinine.In the early postoperative period after heart transplantation, the blood concentration of tacrolimus should be monitored regularly and the drug dose should be adjusted in time according to the test results, and the blood concentration should be strictly controlled not to exceed 15 ng·mL^(-1).