影响骨髓移植术后环孢素A血药浓度的相关因素分析

目的:环孢素A是临床常用的免疫抑制剂,应用于预防骨髓移植术后发生的移植物抗宿主病。环孢素A药代动力学及药效学个体差异大,治疗窗窄,其血药浓度受多种因素影响。本文研究探讨骨髓移植术后患者环孢素A血药浓度,寻找影响其血药浓度变化的可能因素,并为临床上药物使用提供参考依据。方法:以化学发光微粒子免疫分析法测定并记录骨髓移植术后患者应用环孢素A后的血药浓度,并根据环孢素A血药浓度、患者的基本情况(性别、年龄、手术日期等)、用药情况(剂量、给药方式、合并用药等)及相应生化检验结果等,应用SPSS统计软件对数据进行多元线性回归分析,考察环孢素A血药浓度与各生化指标的相关性。结果:环孢素A的单位血药浓度与患者的性别、年龄及体重无明显的相关性,与血浆CHO、AST、BUN、三唑类抗真菌药物具有统计学意义的相关性(P0.05)。结论:环孢素A的血药浓度不仅受自身个体因素的影响,还与给药方式、合用药物情况等外界因素有关。应结合患者的临床表现进行全面分析,建议定期监测血药浓度,及时调整治疗方案,实现个体化给药,使环孢素A在骨髓移植术后的应用得到最佳的治疗效果。

The Analysis Factors of Affecting Cyclosporin A Blood Concentration in the Bone Marrow Transplantation Recipients

Objective:Cyclosporine A is currently used in clinical as an immune inhibitor, and it is applicated in the prevention of bone marrow transplantation after the occurrence of graft-versus-host disease. Because of the individual differences in pharmacokinetic and pharmacodynamic of Cyclosporine A, and it has the narrow therapeutic window, the blood concentration is affected by many factors. This study was to explore blood concentration of Cyclosporine A in patients following bone marrow transplantation, find possible factors affecting the changes in blood concentration, and provide a reference for the clinical use of drugs.Methods:Determination of blood concentration of Cyclosporine A following bone marrow transplantation in patients by Chemiluminesent Microparticle Immunoassay (CMIA). Recording blood concentration following bone marrow transplantation patients with Cyclosporine A and according to Cyclosporine A blood concentration, the basic condition of the patient (age, sex, date of surgery, etc.), drug use (dose, route of administration, concomitant medications, etc.), analyzing with multiple linear regression method by SPSS software, and corresponding results of biochemical tests to study the correlation between Cyclosporine A blood concentration and biochemical markers.Results:It has no significant correlation with gender, age and body weight of blood concentration of Cyclosporine A in patients. Cyclosporine A blood concentration and plasma CHO, AST, BUN, triazole antifungal agents were statistically significantly correlated (P <0.05).Conclusion:The blood concentration of Cyclosporine A is not only affected by its individual factors and external factors, but also the mode of administration, the combination of drug and so on. Multianalysis of the clinical feature of patients should be performed. We suggest monitoring of blood concentration regularly, and adjust the therapeutic protocols, thus to achieve personalized pharmacotherapy and the best treatment results.