再生障碍性贫血患者环孢素A血药浓度监测及其对疗效的影响

Blood cyclosporine A concentration monitoring in patients with aplastic anemia and its impact on the therapeutic efficacy

目的探讨再生障碍性贫血(AA)患者环孢素A(CsA)血药浓度监测的影响因素及其对疗效的影响。方法回顾性分析某院2015年1月至2019年12月确诊为AA并做CsA血药浓度监测的患者110例,对其血药浓度监测数据及临床疗效进行统计分析。结果110例AA患者共行314次CsA血药浓度监测,男性63例(57.3%),监测201次;女性47例(42.7%),监测113次,CsA首次血药浓度监测结果正常的仅占22.7%。性别对AA患者血药浓度监测结果无影响(t=0.317,P=0.752)。成人和儿童血药浓度监测结果比较差异有统计学意义(χ^(2)=206.000,P<0.01)。谷浓度(C0)和给药后2 h浓度(C2)之间具有显著相关性(r=0.363,P=0.003)。不同监测次数的CsA血药浓度监测结果处于目标浓度范围的比例差异有统计学意义(F=4.238,P<0.01),随着CsA血药浓度监测次数的增加,监测结果处于目标浓度范围内的次数也逐渐增加。接受CsA血药浓度监测的AA患者临床总有效率47.3%,监测次数≥3次的患者临床有效率高于<3次的患者(χ^(2)=6.951,P=0.008)。结论CsA血药浓度个体差异大,影响因素较多,对AA患者进行CsA血药浓度监测很有必要,建议对于长期服药的AA患者应定期监测CsA血药浓度,CsA血药浓度监测有助于CsA处于目标浓度范围,有助于提高AA患者的临床治疗效果。

Objective To investigate the factors influencing of blood cyclosporine A(CsA)concentration monitoring in patients with aplastic anemia(AA)and its impact on the therapeutic efficacy.Methods A retrospective analysis was performed for 110 medical records of patients diagnosed with AA and monitored for blood CsA concentration between January 2015 and December 2019 in a hospital.The data on blood CsA concentration monitoring and clinical efficacy were statistically analyzed.Results A total of 314 blood CsA concentration monitoring sessions were performed in the 110 AA patients,including 201 sessions for 63 males(57.3%)and 113 sessions for 47 females(42.7%).Only 22.7%of the first blood CsA concentration monitoring results were normal.Gender was not associated with the monitoring results of blood CsA concentration in AA patients(t=0.317,P=0.752).The proportions of normal blood CsA concentration monitoring results significantly differed between adults and children(χ^(2)=206.000,P=0.000).Significant correlation existed between the trough concentration(C0)and 2 h concentration CsA administration(C2)(r=0.363,P=0.003).There was a significant difference in proportion of blood CsA concentration within the target range across different time points of monitoring(F=4.238,P=0.000).Later sessions of blood CsA concentration monitoring were associated with increasing number of CsA concentration within the target range.The total clinical response rate in AA patients on blood CsA concentration monitoring was 47.3%.Patients who underwent≥3 monitoring sessions showed higher clinical response rate than those with<3 monitoring sessions(χ^(2)=6.951,P=0.008).Conclusion Blood CsA concentration varies greatly among individuals and is affected by various influencing factors.Monitoring of blood CsA concentration is therefore needed for AA patients.It is recommended that blood CsA concentration be monitored regularly for AA patients who are on long-term medications.Such monitoring helps keep CsA concentration within the target range,and is beneficial to improving the clinical efficacy in AA patients.