目的 通过监测分析服用西罗莫司肾移植患者的全血血药浓度,为肾移植患者合理用药提供指导。方法 以郑州大学第一附属医院2013年1月到2015年3月共42例(共410例次)患者监测结果进行比较分析,用化学发光微粒子免疫检测法(CMIA)进行测定西罗莫司血药浓度。结果 在410例次血药浓度监测中,西罗莫司血药浓度为(5.6±2.9) ng·mL-1, 1.02~22.85 ng·mL-1,其中血药浓度4~8 ng·mL-1的为306例次,占74.6%;小于4 ng·mL-1的为46例次,占11.2%;大于8 ng·mL-1的为58例次,占14.2%。血药浓度与谷丙转氨酶,谷草转氨酶,总胆固醇,甘油三酯呈正相关(P<0.05);与血小板数呈负相关(r=-0.231,P<0.05)。结论 西罗莫司治疗窗窄,个体差异大,用药应该遵循个体化给药方案,从而提高临床疗效,减少不良反应的发生。用药时应密切关注血药浓度,及时调整剂量,并严密检测患者血脂情况。
Abstract
OBJECTIVE In those patients by monitoring and analyzing the whole blood concentrations of sirolimus of 410 cases of patients underwent kidney transplant, To provide guidance for the reasonable utilization of medications. METHODS Chemiluminescence microparticles immuno assay (CMIA) was used to determine the whole blood concentrations of sirolimus of 42 patients (410 cases) in the First Affiliated Hospital of Zhengzhou University hospital, from January 2013 to March 2015 years. Then the relationships between the whole blood concentrations of sirolimus and ALT, AST, T-CHO, TG or platelet count were analyzed. RESULTS In our study, the average whole blood concentration of sirolimus of 410 cases was (5.6±2.9) ng·mL-1, ranging from 1.02 to 22.85 ng·mL-1. Three hundred and six cases got concentrations of 4~8 ng·mL-1, accounted for 74.6%. 46 cases(11.2%)got concentrations less than 4 ng·mL-1 and 58 cases with concentrations more than 8 ng·mL-1 accounted for 14.2%. The whole blood concentration of sirolimus of those patients showed positive correlations with ALT, AST, T-CHO, TG(P <0.05) and negative correlation with platelet count(r=-0.231, P<0.05). Patients with abnormal blood drug concentration may be related to compliance, diet, blood volume, genotype, combination and individual differences. CONCLUSION With a narrow therapeutic window, individualized dosage regimens need to be adopted and the blood concentration of which should be monitored when sirolimus was used. Close attention should be paid to the concentration of blood fat, and the blood concrentration of sirolimus need timely adjustment to guarantee a considerable efficacy and reduce the incidence of adverse reactions.
关键词
西罗莫司 /
肾移植 /
血药浓度监测 /
不良反应
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Key words
sirolimus /
kidney transplantation /
blood concentration monitoring /
adverse drug reaction
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中图分类号：
R969.3
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