探讨他克莫司浓度在肺移植早期预后中的价值

To explore the value of tacrolimus concentration in the early prognosis of patients after lung transplantation

目的通过对肺移植术后患者的临床资料的回顾性分析研究,分析术后他克莫司谷浓度与肺移植术后早期预后的相关性。方法回顾性分析2017年1月1日至2020年12月1日无锡市人民医院重症医学科收治的64例行肺移植手术早期预后良好患者(30 d存活)和36例行肺移植手术早期预后不良患者(30 d未存活)的临床资料。根据术后第1天他克莫司谷浓度,分为低他克莫司组(<10 ng/ml)和高他克莫司组(≥10 ng/ml),进行预后分析。运用Cox比例风险模型进行单因素和多因素分析术后他克莫司浓度和其他观察指标对预后生存时间的影响。结果高低他克莫司组肺移植术后患者在30 d存活情况有显著的统计学差异(P<0.05)。根据术后30 d存活情况分组比较,在术前丙氨酸转氨酶、天冬氨酸转氨酶、术后第1天他克莫司谷浓度、急性肾功能不全、术后机械通气时间、重症监护病房的住院天数和原发性移植物失功(primary graft dysfunction,PGD)的分级有显著的统计学差异(P<0.05),单因素Cox回归分析显示,术前丙氨酸转氨酶、天冬氨酸转氨酶、术后第1天他克莫司谷浓度对生存时间的影响具有统计学意义。多因素Cox回归分析显示术后第1天他克莫司谷浓度不是影响生存时间的独立危险因素。结论他克莫司浓度在肺移植术后患者早期预后中有一定价值。

Objective Through a retrospective analysis of clinical data of patients after lung transplantation,the correlation between tacrolimus trough concentration and early prognosis after lung transplantation was analyzed.Methods From January 1,2017 to December 1,2020,the clinical data of 64 patients with good early prognosis of lung transplantation surgery(survival at 30 d)and 36 patients with poor prognosis in the early stage of lung transplantation surgery(30 d of non-survival)were admitted to the Department of Critical Care Medicine of Wuxi People's Hospital.According to the tacrolimus trough concentration on the first day after surgery,the patients were divided into low tacrolimus group(<10 ng/ml)and high tacrolimus group(≥10 ng/ml)for prognostic analysis.The efficacy of tacrolimus and other clinical factors in predicting patients after lung transplantation outcomes were determined using univariate and multivariate Cox proportional hazard analyses.Results There was a significant difference in survival at 30 days after lung transplantation between the high and low tacrolimus group(P<0.05).According to the 30 d survival group comparison,there were significant statistical differences(P<0.05)in preoperative alanine aminotransferase,aspartate aminotransferase,tacrolimus trough concentration on the first postoperative day,acute renal insufficiency,postoperative time of mechanical ventilation,number of days in intensive care uint and primary graft dysfunction(PGD),and univariate Cox regression analysis showed that preoperative alanine aminotransferase,glutamate aminotransferase.The effect of tacrolimus trough concentration on survival time on the first postoperative day was statistically significant.Multivariate Cox regression analysis showed that tacrolimus trough concentration on the first postoperative day was not an independent risk factor for survival time.Conclusion Tacrolimus concentration has some value in the early prognosis of patients after lung transplantation.