性别对肾移植受体霉酚酸血药浓度影响的临床分析

目的  探讨性别对肾移植术后受体霉酚酸(MPA)血药浓度的影响。方法  以115例接受活体肾移植的受体作为研究对象, 根据性别将受体分为两组, 男性为S1组(61例), 女性为S2组(54例)。术后采用他克莫司(每次2 mg, 每日2次)+吗替麦考酚酯(MMF, 每次0.75 g, 每日2次)+泼尼松三联免疫抑制方案至少1周, 检测两组受体服药后1、2、3周和1、2、3个月的MPA血药谷浓度。分析两组受体不良反应发生情况。结果  服药后1、2、3周和1、2、3个月, S1组受体的MPA血药谷浓度均低于S2组, 差异均有统计学意义(均为P < 0.05)。服药后不同时间点S1组与S2组受体MPA血药谷浓度均数的比值较稳定, 波动在0.71~0.84。S1组MPA血药谷浓度 < 1.0 μg/mL者的例数较多, 尤其是服药后1、2周, 达到44%、20%, 而S2组MPA血药谷浓度 > 3.5 μg/mL者的例数较多, 波动在30%~78%。S1组中4例发生急性排斥反应, 其中3例因急性排斥反应导致移植物失功; S2组中7例发生胃肠道紊乱, 3例发生肺部感染。结论 性别对于肾移植受体术后服用MPA类药物的血药浓度有一定影响, 女性受体术后MPA血药谷浓度明显高于男性受体。

Clinical analysis of the influence of gender on blood concentration of mycophenolic acid in recipients undergoing renal transplantation

Objective To investigate the influence of gender on the blood concentration of mycophenolic acid (MPA) in the recipients after renal transplantation. Methods A total of 115 recipients receiving living donor renal transplantation were recruited and divided into the S1 (61 male cases) and S2 groups (54 female cases).After the operation, triple immunosuppressive regimen of tacrolimus (2 mg for each time, twice daily) + mycophenolate mofetil (MMF, 0.75 g for each time, twice daily) + prednisone was administered for at least one week.The trough blood concentration of MPA was statistically compared between two groups at 1-, 2-, 3-week, 1-, 2- and 3-month after drug administration, and the incidence of adverse reactions were analyzed between two groups. Results At 1-, 2-, 3-week, 1-, 2- and 3-month after drug administration, the trough blood concentration of MPA in the S1 group was significantly lower than that in the S2 group (all P < 0.05).At different time points after drug administration, the ratio of the mean trough blood concentration of MPA between the S1 and S2 groups was relatively stable and fluctuated between 0.71 and 0.84.The percentage of recipients with trough blood concentration of MPA < 1.0 μg/mL in the S1 group was high, especially at 1 week (44%) or 2 week (20%) after drug administration.In the S2 group, the proportion of recipients with trough blood concentration of MPA > 3.5 μg/mL was high with the fluctuations ranging from 30% to 78%.In the S1 group, 4 cases suffered from acute rejection, in whom 3 patients had graft failure due to acute rejection.In the S2 group, 7 patients presented with gastrointestinal disorder and 3 had pulmonary infection. Conclusions Gender exerts certain influence on the trough blood concentration of MPA in the recipients after renal transplantation.The trough blood concentration of MPA in the female recipients is significantly higher than that in the male recipients.