肝移植患者他克莫司谷血药浓度监测意义和临床个体化用药调节

目的:探讨移植术后监测他克莫司血药浓度意义和临床药物剂量个体化调节方法。方法:70例肝移植患者术后采用口服他克莫司,每天两次的用药方案,分别在移植后1周和3周监测血液中他克莫司浓度以及外周血单核细胞中钙调磷酸酶活性。结果:移植3周比1周时他克莫司的清除率显著提高。每个采样时间的药物浓度都与0-12 h的浓时间曲线(AUC0-12)下方的面积呈显著的正相关。钙调磷酸酶最低活性与0-12 h的钙调磷酸酶活性-时间曲线显著相关(r20.92)。结论:谷浓度监测是对成年生物配体原位肝移植患者常规他克莫司用药剂量调整的最佳方法,同时监测患者钙调磷酸酶最低活性有助于估计患者在他克莫司用药间隔期的免疫状况。

The Significance of Tacrolimus Blood Concentration Monitoring and ClinicalIndividualized Medication for Liver Transplantation Patients

Objective:To investigate the significance of tacrolimus blood concentration monitoring and clinical drug individualdosage adjustment method.Methods:70 cases of liver transplantation patients had administration of tacrolimus two times daily aftertransplantation. Their blood concentration of tacrolimus and calcineurin activity in PBMC were monitored respectively at one week andthree weeks after transplantation.Results:Acrolimus clearance rate increased significantly at three weeks compared to that at one weekafter transplantation. The drug concentration of each sampling time point was positively related to the area under the concentration-timecurve of 0-12h (AUC0-12). A significant correlation was also found between the lowest calcineurin activity and 0-12 h calcineurinactivity time curves (r2>0.92).Conclusion:Concentration monitoring is the best method for adult patients with LDLT in conventionaltacrolimus dosage adjustment. Simultaneous monitoring of calcineurin activity in patients with the lowest is helpful in estimating theimmune status of patients in the tacrolimus dosing interval period.