中国狼疮性肾炎患者他克莫司清除因素分析

Tacrolimus Clearance Factors in Patients with Lupus Nephritis

目的:对狼疮性肾炎患者他克莫司的血药谷浓度进行监测,结合其标准化谷浓度(ρ_(0)/D)分析狼疮性肾炎患者他克莫司清除因素,为临床合理用药提供参考。方法:以我院2018年01月-2021年12月使用他克莫司的成年狼疮性肾炎患者为研究对象,监测其血药谷浓度,利用多元线性回归分析他克莫司的清除因素。结果:97例狼疮性肾炎患者共进行206例次他克莫司血药谷浓度监测,他克莫司服用剂量为(2.25±0.85)mg/d,血药谷浓度以中浓度(3~10 ng/ml)为主(68.93%),男性患者血药谷浓度高于女性患者[(8.93±9.10)ng/ml vs(6.00±4.29)ng/ml]。性别、体重、血肌酐、24 h尿总蛋白、五酯胶囊日剂量是他克莫司ρ_(0)/D的独立影响因素,为正相关。结论:中国狼疮性肾炎患者他克莫司清除受多因素影响,尤其关注血肌酐和24 h尿总蛋白。临床使用该药时应全面综合考虑多重因素,实现个体化用药。

Objective:This article monitors of tacrolimus blood concentrations in patients with lupus nephritis,and valuates tacrolimus clearance factors through concentration/dose ratio(ρ_(0)/D)of tacrolimus,so as to provide references for rational clinical application.Methods:Patients with lupus nephritis who used tacrolimus from January 2018 to December 2021 were selected and monitored the tacrolimus blood concentrations.Multivariate linear regression analysis was used to analyze the tacrolimus clearance factors.Results:The blood concentration of tacrolimus was detected in 97 patients(206 cases).The mean maintenance dosage of tacrolimus was(2.25±0.85)mg/d.Most trough concentration of tacrolimus was at a middle level(3~10 ng/ml,68.93%).Tacrolimus blood concentrations of male patients were higher than that of female patient(8.93±9.10 ng/ml vs 6.00±4.29 ng/ml).Furthermore,the gender,body weight,serum creatinine,24 h urine protein and daily dose of Wuzhi capsule of lupus nephritis patients showed positive correlations on the level of tacrolimusρ_(0)/D.Conclusion:The tacrolimus clearance was affected by multiple factors,especially serum creatinine and 24 h urine protein.So when tacrolimus is used,multiple factors should be considered comprehensively to achieve individualized treatment.