肺移植术后早期他克莫司血药浓度及影响因素分析

Analysis of tacrolimus blood concentration and influencing factors in the early postoperative period of lung transplantation patients

目的:探讨肺移植受者术后早期他克莫司(tacrolimus,Tac)血药浓度的特点及其影响因素,为肺移植受者术后早期的个体化治疗提供依据。方法:收集2019年1月-2020年9月在某中心行肺移植术的69例肺移植受者的病历资料,对肺移植受者术后30 d内他克莫司的血药浓度与性别、年龄、临床指标及合并唑类抗真菌药进行相关性分析。结果:术后30 d内他克莫司的浓度波动范围较大,达到目标浓度的次数仅占总监测次数的29.7%;年龄、红细胞压积、总胆红素、合并使用伏立康唑和泊沙康唑与他克莫司标准化血药浓度显著相关;合并使用伏立康唑和泊沙康唑后,他克莫司的平均剂量分别降低52.8%和32.5%。结论:肺移植早期影响他克莫司药物浓度的因素较多,需密切监测,且需根据年龄、临床指标和合并唑类抗真菌药的变化及时调整剂量。

OBJECTIVE To explore the clinical characteristics and influencing factors of blood concentration of tacrolimus(Tac)and provide rationales for individualized treatment in early postoperative lung transplant recipients.METHODS From January 2019 to September 2020,medical records were reviewed for 69 lung transplant patients undergoing lung transplantation.And the correlation of blood concentration of Tac with gender,age,clinical indicators and azole antifungal agents within 30 days after transplantation was analyzed.RESULTS Within 30 days post-operation,tacrolimus concentration fluctuated widely and the frequency of reaching the target concentration only accounted for 29.7%of the total monitoring sessions.Age,hematocrit,total bilirubin and combined use of voriconazole&posaconazole were significantly correlated with standardized plasma concentration of Tac.Combined use of voriconazole and posaconazole lowered the mean dose of Tac by 52.8%and 32.5%respectively.CONCLUSION Multiple factors affects the concentration of Tac in early stage of lung transplantation.Under close monitoring,dose should be adjusted timely according to the changes of age,clinical parameters and combined azole antifungal agents.