上海交通大学学报（医学版）

›› 2012, Vol. 32 ›› Issue (4): 473-.doi: 10.3969/j.issn.1674-8115.2012.04.022

• 论著（临床研究） • 上一篇    下一篇

环孢素A血药浓度C0与C2的线性相关性分析对肾移植受者早期临床预后的预示作用

潘隽玮, 王祥慧, 周佩军, 余自成, 徐 达   

  1. 上海交通大学 医学院附属瑞金医院肾脏移植中心, 上海 200025
  • 出版日期:2012-04-28 发布日期:2012-04-27
  • 通讯作者: 王祥慧, 电子信箱: wxh4270@sina.com。
  • 作者简介:潘隽玮（1985—）, 男, 硕士生；电子信箱: pjw_wqsguitar@sina.com。
  • 基金资助:

    卫生部国际交流与合作课题（IHECC07001）；上海市科委基金上海市器官移植重点实验室研究项目（10DZ2212000）

Linear correlation of C0 with C2 of plasma concentrations of cyclosporin A in prediction of early clinical outcomes of recipients after renal transplantation

PAN Jun-wei, WANG Xiang-hui, ZHOU Pei-jun, YU Zi-cheng, XU Da   

  1. Kidney Transplantation Center, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
  • Online:2012-04-28 Published:2012-04-27
  • Supported by:

    Foundation of the Ministry of Health of China, IHECC07-001；Shanghai Science and Technology Committee Foundation, 10DZ2212000

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摘要：

目的 探讨环孢素A（CsA）药代动力学参数的个体内变异度对肾脏移植受者移植后早期临床预后的影响。方法 以移植后早期接受CsA、吗替麦考酚酯（MMF）、皮质激素三联免疫抑制治疗的44例同种异体肾脏移植受者作为研究对象，采用酶增强免疫法(EMIT)法测定CsA和MMF的活性成分霉酚酸（MPA）的血药浓度，包括用药前谷值（C0）和用药后2 h 峰值（C2），分析CsA C0与CsA C2的线性相关性并依此分组（相关组和非相关组），比较两组移植术后早期各项临床事件（感染、急性排斥、急性排斥和感染合并、移植肾失功和CsA肝、肾毒性反应等）的发生率和MPA血药浓度-时间曲线下面积（AUCMPA）的达标率。结果 44例患者中，CsA C0与CsA C2呈非线性相关者31例(70.45%)，呈线性相关者13例(29.55%)。统计学分析结果显示：相关组与非相关组移植后第2~4周临床事件的总体发生率、急性排斥事件的发生率和AUCMPA的达标率比较，差异均有统计学意义（P≤0.05）。结论 CsA药代动力学参数C0与C2的线性相关性对肾脏移植受者移植后早期的临床预后有预示作用。

关键词: 环孢素A, 药代动力学, 血药浓度, 谷值, 峰值, 线性相关性, 肾脏移植

Abstract:

Objective To investigate the effects of pharmacokinetic intra-variability of cyclosporin A (CsA) on early clinical outcomes of recipients after renal transplantation. Methods Forty-four recipients undergoing triple immunosuppressive therapy of CsA, mycophenolate mofetil (MMF) and corticosteroid early after allogeneic renal transplantation were selected. The plasma concentration of mycophenolic acid (MPA), which was the active component of CsA and MMF, was measured with enzymemultiplied immunoassay technique (EMIT), including the valley value before medication (C0) and peak value 2 h after medication (C2), and the linear correlation of CsA C0 with CsA C2 was analysed. Correlation group and non-correlation group were divided according to the results of correlation analysis, the prevalences of clinical events (infection, acute rejection, acute rejection combined with infection, dysfunction of transplanted kidney, liver and renal toxic reaction to CsA) and qualification rates of area under the curve of plasma concentration of MPA-time （AUCMPA）early after transplantation were compared between groups. Results There was non-linear correlation of CsA C0 with CsA C2 in 31 patients (70.45%), and there was linear correlation in 13 patients (29.55%). Statistic analysis revealed that there were significant differences in the prevalences of all clinical events 2 to 4 weeks after transplantation, prevalence of acute injection 2 to 4 weeks after transplantation and qualification rate of AUCMPA 2 to 4 weeks after translplantation between correlation group and noncorrelation group (P≤0.05). Conclusion The linear correlation of C0 with C2 of pharmacokinetic parameters of CsA may predict the early clinical outcomes of recipients after renal transplantation.

Key words: cyclosporin A, pharmacokinetic, plasma drug concentration, valley value, peak value, linear correlation, renal transplantation