目的 运用文献计量学方法,分析他克莫司(FK-506)治疗重症肌无力的研究进展,为临床安全合理用药提供数据支持。方法 以他克莫司、tacrolimus、FK-506为关键词,检索PubMed、Embase、Cochrane、Web of Science、CNKI、万方、维普等数据库,时间自1990年1月至2017年11月。用Endnote X7对纳入文献的年代、期刊名称、作者及研究机构情况、文献类型、研究内容、被引频次等进行统计,分析研究热点问题。结果 共纳入来自18个国家的184篇,文献类型:论著(100篇,54%)、病例讨论(41篇,22.2%)、综述(43篇,23.2%)。首篇文献发表于1990年。研究主要集中在日本。单篇文章被引频次最高的为61次。他克莫司是重症肌无力长期治疗的二线治疗药物,适用于对传统免疫制剂反应不佳或不耐受的患者。结论 日本在他克莫司研究领域发挥重要作用。他克莫司口服生物利用度低,个体差异较大,药物相互作用多,临床应结合治疗药物监测结果,调整剂量,降低不良反应发生率。
Abstract
OBJECTIVE To analyze the research on tacrolimus (FK-506) in the treatment of myasthenia gravis and provide support on clinical treatment. METHODS Databases including PubMed, Embase, Cochrane, Web of Science, CNKI, Wan Fang, VIP database were searched with time ranging from inception of databases to November 30, 2017. Endnote X7 was used to make statistical analysis of the publishing year, journal names, authors and research institutions, literature types, research contents and cited frequency. RESULTS A total of 184 articles from 18 countries were included. Types of literature: (100 articles, 54%) case discussions (41 articles, 22.2%), reviews (43 articles, 23.2%). First articles were published in 1990. Researches were mainly conducted in Japan. The most frequency was 61. Tacrolimus is a second-line treatment for the long-term treatment of myasthenia gravis. It is suitable for patients with poor response or intolerance to conventional immune preparations. CONCLUSION Japan plays an important role in tacrolimus research. Tacrolimus has low oral bioavailability, large individual differences, and many drug interactions. Myasthenia gravis treatment should be based on therapeutic drug monitoring to reduce adverse reactions.
关键词
他克莫司 /
重症肌无力 /
文献计量分析 /
临床疗效 /
不良反应
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Key words
tacrolimus /
myasthenia gravis /
bibliometric analysis /
therapeutic effect /
adverse reaction
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中图分类号：
R969.3
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参考文献
[1] China guidelines for the diagnosis and treatment of myasthenia gravis. Chin J Neurol (中华神经科杂志), 2015, 48(11):934-940.
[2] BU B. Mononuclear cell subsets in the peripheral blood of patients with myasthenia gravis. Chin J Neurol Psychiatry(中华神经精神科杂志),1990, 23(3): 140-142, 188-189.
[3] ZHAO C B, ZHU W H, LU J H. The preliminary clinical study of low-dose tacrolimus in the treatment of refractory generalized myasthenia gravis . Chin J Clin Neurosci(中国临床神经科学), 2005, 13 (4):406-409.
[4] YOSHIKAWA H, IWASA K, SATOH K, et al. FK506 prevents induction of rat experimental autoimmune myasthenia gravis. J Autoimmun, 1997,10(1): 11-16.
[5] OETTING W S, WU B, SCHLADT D P, et al. Genome-wide association study identifies the common variants in CYP3A4 and CYP3A5 responsible for variation in tacrolimus trough concentration in Caucasian kidney transplant recipients. Pharmacogenomics J, 2017, 18(5):501-505.
[6] CRUZ L, WOLFF M L, VANDERMAN A J, et al. The emerging role of tacrolimus in myasthenia gravis. The Adv Neurol Disord, 2015,8(2): 92-103.
[7] SIKMA M A, MAARSEVEEN E M V, GRAAF E A, et al. Pharmacokinetics and toxicity of tacrolimus early after heart and lung transplantation. Am J Transplant, 2015, 15(9): 2301-2313.
[8] UTSUGISAWA K, NAGANE Y. Therapeutic strategies against myasthenia gravis. Nihon Rinsho, 2013,71(5): 881-886.
[9] PONSETI J M, GAMEZ J, AZEM J, et al. Tacrolimus for myasthenia gravis: a clinical study of 212 patients. Ann N Y Acad Sci, 2008, 1132(1): 254-263.
[10] PONSETI J M, AZEM J, FORT J M, et al. Long-term results of tacrolimus in cyclosporine-and prednisone-dependent myasthenia gravis. Neurology, 2005,64(9):1641-1643.
[11] NAGANE Y, UTSUGISAWA K, OBARA D R, et al. Efficacy of low-dose FK506 in the treatment of myasthenia gravis--a randomized pilot study. Eur Neurol, 2005,53(3):146-150.
[12] LIU C, GUI M, CAO Y, et al. Tacrolimus improves symptoms of children with myasthenia gravis refractory to prednisone. Pediatr Neurol, 2017, 77: 42-47.
[13] GOTTERER L, LI Y. Maintenance immunosuppression in myasthenia gravis. J Neurol Sci, 2016, 369 (10):294-302.
[14] KONISHI T, YOSHIYAMA Y, TAKAMORI M, et al. Long-term treatment of generalised myasthenia gravis with FK506 (tacrolimus). J Neurol Neurosurg Psychiatry, 2005, 76(3): 448-450.
[15] PONSETI J M, GAMEZ J, AZEM J, et al. Post-thymectomy combined treatment of prednisone and tacrolimus versus prednisone alone for consolidation of complete stable remission in patients with myasthenia gravis: a non-randomized, non-controlled study. Curr Med Res Opin, 2007, 23(6):1269-1278.
[16] ZHAO C B, ZHANG X, ZHANG H, et al. Clinical efficacy and immunological impact of tacrolimus in Chinese patients with generalized myasthenia gravis. Int Immunopharmacol, 2011, 11(4): 519-524.
[17] BEKERSKY I, DRESSLER D, MEKKI Q A. Effect of low-and high-fat meals on tacrolimus absorption following 5 mg single oral doses to healthy human subjects. J Clin Pharmacol, 2001,41(2): 176-182.
[18] SPITMAN A B, MOES D J A R, GELDERBLOM H, et al. Effect of CYP3A4*22, CYP3A5*3, and CYP3A combined genotypes on tamoxifen metabolism. Eur J Clin Pharmacol, 2017,73(12): 1589-1598.
[19] STAATZ C E, GOODMAN L K, TETT S E. Effect of CYP3A and ABCB1 single nucleotide polymorphisms on the pharmacokinetics and pharmacodynamics of calcineurin inhibitors: part Ⅱ. Clin Pharmacokinet, 2010, 49(3): 141-175.
[20] WANG D, SADEE W. CYP3A4 intronic SNP rs35599367 (CYP3A4*22) alters RNA splicing. Pharmacogenet Genomics, 2016,26(1): 40-43.
[21] CHEN D,HOU S F,ZHAO M, et al. Analysis of tacrolimus therapeutic drug monitoring and influence factor in myasthenia gravis patients. Chin Pharm J(中国药学杂志),2018,53(4): 295-299.
[22] WU X, WHITFIELD L R, STEWART B H. Atorvastatin transport in the Caco-2 cell model: contributions of P-glycoprotein and the proton-monocarboxylic acid co-transporter. Pharm Res, 2000, 17(2): 209-215.
[23] AHN S W, JOO I S, KIM B J, et al. A multicenter prospective observational study on the safety and efficacy of tacrolimus in patients with myasthenia gravis. J Neurol Sci, 2017, 379: 271-275.
[24] THOLKING G, GERTH H U, SCHUETTE-NUETGEN K, et al. Influence of tacrolimus metabolism rate on renal function after solid organ transplantation. World J Transplant, 2017,7(1): 26-33.
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脚注
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基金
北京医院院级科研课题项目资助(bj-2018-014)
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