免疫抑制剂治疗药物监测在器官移植领域的应用进展

Application progress on therapeutic drug monitoring of immunosuppressants in organ transplantation

排斥反应是影响异体器官移植术后移植器官长期存活的独立危险因素,免疫抑制剂的应用可预防排斥反应发生,极大地提高了患者移植物的存活率,但临床上在使用免疫抑制剂过程中,需要对治疗药物进行浓度监测。目前常用的检测方法有免疫分析法及色谱法,其中液相色谱串联质谱法因具有专属性强、准确度高、分析快速、灵敏度高等优点,大多数临床实验室以该测定方法作为治疗药物监测的金标准。基于临床常用免疫抑制剂的药理及药动学特性,将免疫抑制剂的检测方法分为全血型免疫抑制剂的检测与血浆型免疫抑制剂的检测,并分别对两类药物的血药浓度监测方法进行综述,旨在为免疫抑制剂在器官移植领域的临床安全合理用药提供更直接的指导依据。

Rejection is an independent risk factor affecting the long-term survival of transplanted organs after allogeneic organ transplantation.The application of immunosuppressants can prevent rejection and greatly improve the survival rate of patient transplants.At present,the commonly used detection methods for the detection of immunosuppressants include immunoassay and chromatography.Liquid chromatography tandem mass spectrometry has the advantages of strong specificity,high accuracy,fast analysis,and high sensitivity,and is the "gold standard" in most clinical laboratories for therapeutic drug monitoring of immunosuppressants.Based on the pharmacological and pharmacokinetic characteristics of immunosuppressants commonly used in clinical practice,the detection methods of immunosuppressants are divided into immunosuppressant in blood and immunosuppressant in plasma,and the monitoring methods are reviewed,aiming to provide more significant and direct guidance for immunosuppressants clinical rational drug use application in organ transplantation.