上海交通大学学报（医学版）

上海交通大学学报（医学版）

• 论著（临床研究） • 上一篇    下一篇

霉酚酸治疗药物监测有利于减少肾移植受者皮质类固醇激素的用量

杨 洋，周佩军，徐 达，王祥慧，邵 琨，师天明   

  1. 上海交通大学 医学院附属瑞金医院泌尿外科， 上海 200025
  • 出版日期:2014-10-28 发布日期:2014-10-28
  • 通讯作者: 周佩军, 电子信箱: peijunzhou@yahoo.com.cn。
  • 作者简介:杨 洋（1989—）， 男， 硕士生; 电子信箱: yangyangde_2011@163.com

Reducing dosage of corticosteroid by mycophenolate acid therapeutic drug monitoring for renal allograft recipients

YANG Yang, ZHOU Pei-jun, XU Da, WANG Xiang-hui, SHAO Kun, SHI Tian-ming   

  1. Department of Urology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
  • Online:2014-10-28 Published:2014-10-28

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摘要：

目的 对处于免疫抑制维持治疗期的肾移植受者，在进行霉酚酸（MPA）治疗药物监测（TDM）并指导霉酚酸酯（MMF）合理应用的基础上，减少皮质类固醇激素的用量并评价其有效性及安全性。方法 80例肾移植受者，均接受CsA+MMF+Pred三联免疫抑制方案治疗，随机分为MPA TDM组和对照组。MPA TDM组患者，通过有限采样法的简化公式，计算肾移植受者MPA血药浓度-时间曲线下面积（AUC），并根据MPA-AUC调整MMF剂量，使MPA-AUC0~12 h达到30~60 mg·h-1·L-1，皮质类固醇激素（Pred）剂量减少50%以上。对照组患者，采用相对固定的MMF剂量，同时皮质类固醇激素不减量。比较2组患者移植物排斥反应、各种不良反应的发生率，以及空腹血糖的差异。结果 MPA TDM组和对照组患者中，移植肾功能、移植物排斥反应、各种不良反应的发生率、CsA及MMF的服用剂量差异无统计学意义（P>0.05）；Pred的用量分别为（2.77±0.79）mg/d和（6.00±1.77）mg/d，差异有统计学意义（P<0.05）；空腹血糖水平分别为（5.36±0.50）mmol/L和（5.78±1.19）mmol/L，差异有统计学意义（P<0.05）。结论 免疫抑制维持治疗期的肾移植受者，在进行MPA治疗药物监测并合理调整MMF剂量的基础上，可安全、有效地减少皮质类固醇激素的用量。

关键词: 肾移植, 霉酚酸, 治疗药物监测, 皮质类固醇, 低剂量

Abstract:

Objective To reduce the dosage of corticosteroids and to evaluate its efficiency and safety based on mycophenolate acid (MPA) therapeutic drug monitoring (TDM) and rational use of mycophenolate mofetil (MMF) for renal allograft recipients during the maintenance period of immunosuppressive therapy. Methods Eighty kidney transplant recipients who underwent CsA+MMF+Pred triple immunosuppressive therapy were selected and randomly divided into the MPA TDM group and control group. For patients of the MPA TDM group, the area under the plasma MPA concentration-time curve (MPA-AUC) was calculated by the simplified formula of limited sampling method. The dosage of MMF was adjusted according to the MPA-AUC, so the range of MPA-AUC0-12 h  reached 30-60 mg·h-1·L-1 and the dosage of corticosteroid was reduced by at least 50%. For patients in the control group, relatively fixed dosage of MMF was used and the dosage of corticosteroids was not reduced. The incidence of graft rejection and various adverse reactions and the level of fasting blood glucose of two groups were compared. Results For patients of the MPA TDM group and control group, the differences of functions of the allograft, incidence of graft rejection and various adverse reactions, and the dosage of CsA and MMF were not statistically significant (P>0.05). Dosages of prednisone of the MPA TDM group and control group were (2.77±0.79) mg/d and (6.00±1.77)mg/d, respectively, and the difference was statistically significant (P<0.05). Fasting plasma glucose levels of the MPA TDM group and control group were (5.36±0.50) mmol/L and (5.78±1.19) mmol/L, and the difference was statistically significant (P<0.05). Conclusion For renal transplant recipients, the dosage of corticosteroids can be safely and effectively reduced based on the MPA TDM and rational use of MMF during the maintenance period of immunosuppressive therapy.

Key words: kidney transplantation, mycophenolate acid, therapeutic drug monitoring, corticosteroids, low dosage