服用微乳化环孢素A的长期存活肾移植患者血环孢素浓度监测的回顾性分析

Retrospective study of two-hour post-dose cyclosporine level (C_2) monitoring in long term maintenance phase of renal transplant recipients

目的 探讨服用微乳化环孢素A(CsA)的长期存活肾移植受者血CsA浓度监测的意义。方法 回顾性分析 12 6例存活 1年以上的肾移植患者术后血CsA浓度的资料 ,入选受者术后存活 1～ 17年 ,随访期间患者均接受微乳化CsA、霉酚酸酯 (或硫唑嘌呤 )及泼尼松预防排斥反应 ,CsA浓度测定采用免疫荧光偏振TDx法。分析服药后 2h血CsA浓度 (C2 )变化及其与药物剂量、移植肾功能之间的关系。结果 C2 随术后时间的延长逐渐降低 ,但个体间的变异度随时间延长而逐渐加大 ;肾移植后的前 5年 ,C2 与服药剂量以及移植肾功能呈显著正相关关系 ,肾移植后 10年以上的受者C2 与肾功能关系不明显。结论 对于存活 1年以上的肾移植受者 ,C2 仍然是药物调控的一个有效指标 ,但随移植时间的延长 ,C2 的变异度逐渐加大。

Objective To evaluate the clinical value of two-hour post-dose cyclosporine (CsA) level (C 2) monitoring in renal transplantation (RTx) recipients with functional renal allograft more than one year.Methods 126 RTx recipients with functional renal allograft more than one year treated with CsA-microemulsion-based triple therapy immunosuppression were enrolled. Whole blood samples were collected 2?h after CsA administration and the CsA level was measured by fluorescence polarization immunoassay (TDx).Results C 2 levels at 3 month and 1 year following RTx were 0.830 ± 0.307 ?μmol/L and 0.678 ± 0.306 ?μmol/L respectively, average C 2 level between 1 to 5 years was 0.609 ± 0.195 ?μmol/L,and after 5 and 10 years, C 2 levels decreased to 0.546 ± 0.163 ?μmol/L and 0.547 ± 0.227 ?μmol/L respectively. Adequate C 2 level in the first 5 years after RTx was correlated with improved allograft renal function and there was a significant relationship between C 2 level and CsA dose. Variation of C 2 level became greater in long-term survival RTx recipients.Conclusion In long term maintenance phase of RTx recipients, C 2 concentration was also useful in the CsA therapeutic monitoring, but the variation became greater in such patients.