肾移植术后并发结核病患者服用利福喷汀对他克莫司血药浓度的影响

Effect of rifapentine on blood concentration of tacrolimus in patients with tuberculosis after kidney transplantation

目的探讨肾移植术后并发结核病患者服用利福喷汀对他克莫司血药浓度的影响,为无血药浓度监测条件的医院提供粗略的免疫抑制剂调整方向。方法回顾性分析13例肾移植术后并发结核病患者的临床资料,均服用他克莫司作为免疫抑制治疗,比较服用利福喷汀前后他克莫司血药浓度、肾功能指标变化,以及不同性别、年龄患者血药浓度的差异。结果联合利福喷汀用药后他克莫司血药浓度降低(6.09±4.99)μg/L,降低了2.3倍,平均降低水平为55.81%,最高达92.67%,降低的发生率为69.23%,有效血药浓度达标率下降60.01%,用药前后血药浓度差异有显著统计学意义(P=0.034),肾功能指标变化、不同性别、年龄患者血药浓度差异无显著统计学意义。结论肾移植术后并发结核病患者抗痨方案中合用的利福喷汀较显著地降低了他克莫司有效血药浓度的达标率,影响抗排斥疗效,服药期间应严密监测他克莫司的血药浓度,及时调整剂量,避免引起排斥反应。

Objective To explore the effect of rifapentine on the blood concentration of tacrolimus in patients with tuberculosis after kidney transplantation and guide the rough adjustment of immunosuppressive for the hospitals without the monitoring capacity of blood concentration.Methods The clinical data of 13 patients with tuberculosis after kidney transplantation were retrospectively analyzed,who were treated with tacrolimus as immunosuppressive therapy.The blood concentration of tacrolimus and renal function indexes,patients of different genders and ages were compared before and after rifapentine administration.Results After administering rifapentine,the blood concentration of tacrolimus decreased by 2.3 times to(6.09±4.99)μg/L.The average reduction was 55.81%,and the highest reduction reached 92.67%.The incidence of reduction was 69.23%.The effective blood concentration rate fell by 60.01%.It had significant difference before and after administering rifapentine(P=0.034).The renal function indexes,among genders and ages had no significant difference.Conclusion Rifapentine can significantly reduce the effective blood concentration rate of tacrolimus in patients with tuberculosis after kidney transplantation,which leads to compromised anti-rejection result.Hence,during administering rifapentine,the blood concentration of tacrolimus should be closely monitored,and the dosage should be adjusted in time to avoid the rejection.