中国组织工程研究

中国组织工程研究 ›› 2011, Vol. 15 ›› Issue (5): 843-846.doi: 10.3969/j.issn.1673-8225.2011.05.020

• 移植与免疫 transplantation and Immunology • 上一篇    下一篇

肾移植后早期监测环孢素A血药浓度峰值的临床意义

万有贵1，陈  博1，徐志强1，高宝山2   

  1. 1通辽市医院泌尿外科，内蒙古自治区通辽市   028200
    2吉林大学第一医院泌尿系统疾病诊治中心，吉林省长春市   130021
  • 收稿日期:2010-07-22 修回日期:2010-12-26 出版日期:2011-01-29 发布日期:2011-01-29
  • 通讯作者: 高宝山，在读博士，主治医师，主要从事肾移植的研究，吉林大学第一医院泌尿系统疾病诊治中心，吉林省长春市 130021 chenmuxin1999@163.com
  • 作者简介:万有贵，男，1962年生，内蒙古自治区通辽市人，汉族，1984年内蒙古医学院毕业，副主任医师，主要从事泌尿系统疾病的研究。 chenmuxin@126.com

Clinical significance of monitoring cyclosporine A concentration at early stage following kidney transplantation

Wan You-gui1, Chen Bo1, Xu Zhi-qiang1, Gao Bao-shan2   

  1. 1Department of Urinary Surgery, Tongliao City Hospital, Tongliao  028200, Inner Mongolia Autonomous Region, China
    2Urinary System Disease Center, the First Hospital of Jilin University, Changchun  130021, Jilin Province, China
  • Received:2010-07-22 Revised:2010-12-26 Online:2011-01-29 Published:2011-01-29
  • Contact: Gao Bao-shan, Studying for doctorate, Attending physician, Urinary System Disease Center, the First Hospital of Jilin University, Changchun 130021, Jilin Province, China chenmuxin1999@163.com
  • About author:Wan You-gui, Associate chief physician, Department of Urinary Surgery, Tongliao City Hospital, Tongliao 028200, Inner Mongolia Autonomous Region, China chenmuxin@126.com

PDF

504

被引次数

12

摘要：

背景：近几年有报道，检测环孢素A的峰浓度可以更准确地反映环孢素A在体内的药代动力学变化，指导移植后的临床用药比检测谷浓度更合理，而对大样本临床资料统计的研究报道较少。
目的：探讨肾移植后早期监测环孢素A血药浓度峰值对判定环孢素A抗排异疗效及毒副作用的临床意义。
方法：采用单抗免疫荧光偏振法同步监测环孢素A全血谷浓度和峰浓度，回顾性分析78例肾移植受者，移植后观察6个月，48例未发生任何移植后并发症设为正常组，16例发生急性排异反应设为急性排斥反应组，14例出现药物性损害设为药物损害组，观察各组谷浓度及峰浓度在患者发生急性排斥反应或药物毒性时的变化。
结果与结论：移植后各时间段发生急性排异患者环孢素A谷浓度与未发生的比较，差异无显著性意义(P  > 0.05)，而各时间段发生急性排斥反应患者环孢素A峰浓度明显低于正常组(P < 0.05)。移植后1个月内，发生药物性肝损害、肾中毒患者谷浓度和峰浓度均明显高于未发生的(P  < 0.05)。移植后2~6个月，药物性肝损害、肾中毒组谷浓度与常组比较差异无显著性意义(P  > 0.05)，而峰浓度明显高于正常组(P < 0.05)。提示，监测环孢素A峰浓度能有效预测肾移植后急性排异反应的发生；移植后2~6个月监测环孢素A峰浓度能有效预测肾移植后药物性肝损害、肾中毒的发生。

关键词: 环孢素, 血药浓度, 肾移植, 血药浓度峰值, 排斥反应

Abstract:

BACKGROUND: In recent years, monitoring of cyclosporine A peak plasma concentration (C2) can be more accurately reflect pharmacokinetical changes of cyclosporine A in vivo, which is more reasonable to guide clinical medication than detection valley concentration (C0). However, the statistics addressing large sample clinical data are few. 
OBJECTIVE: To explore the clinical significance of monitoring C2 and C0 levels to determine the anti-rejection drug efficacy and side effect of cyclosporine for early postoperative of renal transplant patients.
METHODS: TDX was used to synchronization monitoring C0 and C2. Totally 78 cases of kidney transplantation were retrospective analyzed. According 6-month observation, 48 cases with out complications served as normal group, 16 cases with acute rejection served as acute rejection group, and 14 cases appeared intoxication served as intoxication group. The changes of C0 and C2 during acute rejection and drug toxicity were observed.  
RESULTS AND CONCLUSION: There was no significant difference in C0 level prior to and after acute rejection (P > 0.05), both of which were lower than that of the normal group (P < 0.05). At 1 month after transplantation, C0 and C2 levels of intoxication group were obviously greater than that of the normal group (P < 0.05). At 2-6 months after transplantation, there was no significance between the intoxication group and the normal group in C0 (P > 0.05), but C2 was obviously increased in the intoxication group (P< 0.05). The findings demonstrated that monitoring C2 can effective predict the occurrence of acute rejection after kidney transplantation; C2 detection at 2-6 months after transplantation can predict the occurrence of liver damage and nephropathy.

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