中国组织工程研究

中国组织工程研究 ›› 2010, Vol. 14 ›› Issue (5): 794-798.doi: 10.3969/j.issn.1673-8225.2010.05.009

• 肾移植 kidney transplantation • 上一篇    下一篇

稳定期肾移植受者微乳化环孢素峰浓度监测

张  勇，张小东，王  勇，胡小鹏，李晓北，王  玮，尹  航，刘  航   

  1. 首都医科大学附属北京朝阳医院泌尿外科，北京市  100020
  • 出版日期:2010-01-29 发布日期:2010-01-29
  • 作者简介:张 勇☆，男，1972年生，河北省南宫县人，汉族，2008年首都医科大学毕业，博士，副主任医师，副教授，硕士生导师，主要从事肾移植和泌尿外科的研究。 doctorzhy@126.com

Monitoring of Ciclosporin peak concentration in recipients during the stable stage following renal transplantation

Zhang Yong, Zhang Xiao-dong, Wang Yong, Hu Xiao-peng, Li Xiao-bei, Wang Wei, Yin Hang, Liu Hang   

  1. Department of Urinary Surgery, Chaoyang Hospital of Capital Medical University, Beijing  100020, China
  • Online:2010-01-29 Published:2010-01-29
  • About author:Zhang Yong☆, Doctor, Associate chief physician, Associate professor, Master’s supervisor, Department of Urinary Surgery, Chaoyang Hospital of Capital Medical University, Beijing 100020, China doctorzhy@126.com

PDF

435

摘要：

背景：文献报道微乳化环孢素峰浓度(C2)与药物曲线下面积的相关性最好，个体差异最大，根据C2调整环孢素用量，可最大程度地达到用药个体化，明显降低急性排斥和药物中毒发生率，已经被广泛用于肾移植受者的围手术期治疗。但是对于稳定期肾移植受者环孢素用量的监测，仍有部分中心延用环孢素谷浓度(C0)。
目的：探讨稳定期肾移植受者由监测微乳化环孢素C0改为监测C2的可行性及其安全性。
方法：肾移植受者65例，男31例，女34例，年龄21~57(39.4±15.3)岁。纳入试验前3个月内，无临床排异反应，血肌酐、尿素氮稳定，血肌酐≤180 μmol/L，临床判断为肾移植后稳定期。记录本组患者移植时间、移植肾功能等病例资料，测定微乳化环孢素C2和C0。按照C2目标值为500~600 μg/L的水平，前瞻性地将受者随机分为3组，高C2组(n=17)：减少微乳化环孢素用量，使C2降至500~600 μg/L的目标值；目标C2组(n=23)：微乳化环孢素用量不变；低C2组(n=25)：增加微乳化环孢素用量，使C2升至500~600 μg/L的目标值。随访3组患者12个月，比较移植肾功能和重要脏器并发症。
结果与结论：高C2组按C2目标值减少微乳化环孢素575.0 mg，88%的患者血肌酐、尿素氮稳定，部分患者血压、血脂、血尿酸下降。目标C2组随访12个月，无心、肺、脑等脏器并发症，血肌酐、尿素氮、微乳化环孢素C0和C2稳定。低C2组按C2目标值增加微乳化环孢素755.0 mg，84%的患者血肌酐、尿素氮稳定。无心、肺、脑等重要脏器并发症。提示按照C2为500~600 μg/L的目标值，稳定期肾移植受者由监测微乳化环孢素C0改为监测C2调整微乳化环孢素的用量是可行和安全的。

关键词: 微乳化环孢素, 峰浓度, 谷浓度, 安全性, 肾移植

Abstract:

BACKGROUND: Documents recorded that the correlation between micro emulsion Ciclosporin peak concentration (C2) and area under curve was best with maximum individual difference. According to C2, dose of Ciclosporin can be adjusted individually to decrease acute rejection and Ciclosporin toxicity, which has widely used in perioperative stage of renal transplanted recipients. However, some transplantation center still used tough concentration (C0) to adjust the dose of Ciclosporin in stable stage of renal transplanted recipients.
OBJECTIVE: To analyze the efficacy and safety of changing from monitoring C0 to C2 in stable stage recipients following renal transplantation.
METHODS: Totally 65 patients with renal transplantation were enrolled in this study, including 31 males and 34 females, aged 20-57 (39.4±15.3) years. Within 3 months prior to this study, all patients did not suffered from rejection, and their serum creatinine and urea nitrogen were stable (creatinine ≤180 μmol/L). They were in stable stage after renal transplantation. Their period of transplantation and function of allograft were recorded. Their C0 and C2 of Ciclosporin were assayed. According to the target C2 value 500-600 μg/L, the patients were prospectively and randomly divided into 3 groups. In the high C2 group (n=17), the dose of Ciclosporin was decreased. In the target C2 group (n=23), the dose of Ciclosporin was remained. In the low C2 group (n=25), the dose of Ciclosporin was increased. All of the patients were followed-up for 12 months. The grafts function and the complications of heart, lung and brain were compared.
RESULTS AND CONCLUSION: According to the target concentration of Ciclosporin C2, the dose of Ciclosporin in the high C2 group was decreased by 575.0 mg. The Creatinine and urea nitrogen of 88% patients were stable, while blood pressure, blood fat and blood uric acid decreased in parts of patients. In the target C2 group, the levels of creatinine, urea nitrogen, C0 and C2 of patients were stable, no complications of heart, lung and brain occurred. According to the target concentration of Ciclosporin C2, the dose of Ciclosporin in low C2 group was increased by 755.0 mg. The creatinine and urea nitrogen of 84% patients were stable. All of the patients were no complications of heart, lung and brain. It is safe and effective to adjust Ciclospori dose under C2 monitoring according to the target peak concentration (500-600 μg/L) in most stable stage recipients following renal transplantation.

中图分类号: