儿童肾病综合征患者他克莫司血药浓度影响因素分析

Analysis of influence factors of tacrolimus concentration in pediatric patients with nephrotic syndrome

目的:分析肾病综合征(nephrotic syndrome,NS)患儿他克莫司血药浓度监测结果,探讨他克莫司血药浓度影响因素。方法:回顾性收集2018年1—6月于我院使用他克莫司治疗的NS患儿86例,共147例次血药浓度监测结果,记录用药情况,分析年龄、性别、肝肾功指标、合并用药等与他克莫司血药浓度的相关性。结果:他克莫司血药浓度(5. 23±3. 27) ng·mL-1,在有效血药浓度范围内的占40. 14%;年龄越大,给药剂量越少;肝功能与他克莫司血药浓度呈弱相关;合用ARB类、CCB类药物及五酯片有助于提高他克莫司血药浓度。结论:患儿年龄、肝功能及合用某些药物能够影响他克莫司血药浓度,其中ARB类药物、CCB类药物及五酯片可提高其血药浓度。临床医师和药师应遵循个体化用药原则,根据血药浓度的影响因素制定和调整他克莫司用药方案。

Objective:To investigate the influence factors of tacrolimus blood concentration in pediatric patients with nephrotic syndrome.Methods:Data of tacrolimus use were retrospectively collected from January 2018 to June 2018 in 86 patients with 147 tacrolimus blood concentrations in our hospital.Correlations of dose,age,sex,drug combination,routine blood indexes,hepatic and kidney function indexes with tacrolimus blood concentrations were analyzed.Results:The tacrolimus blood concentration was(5.23±3.27)ng·mL-1,and 40.14%of the samples were in the effective range.The dose of tacrolimus decreased with age.Weak correlations were found between liver function indexes and tacrolimus blood concentrations.Combination with ARB,CCB and Wuzhi tablets could promote tacrolimus blood concentration.Conclusion:Age,liver function and combination use of drugs might affect the whole blood concentration of tacrolimus in pediatric patients with nephrotic syndrome.Physicians and clinical pharmacists should evaluate the patients comprehensively to give proper initial dose and adjust dose timely after therapeutic drug monitoring.