再生障碍性贫血患者环孢素A血药浓度的监测

目的明确再生障碍性贫血患者全血中环孢素A谷浓度与疗效的关系。方法采用荧光偏振免疫法(FPIA)测定33例再生障碍性贫血患者55例血药浓度,按治疗方案分4组,A组:环孢素A+雄激素+造血细胞生长因子;B组:环孢素A+雄激素+造血细胞生长因子+大剂量甲泼尼龙;C组:环孢素A+雄激素+造血细胞生长因子+抗胸腺细胞球蛋白(ATG);D组:环孢素A+雄激素+造血细胞生长因子+大剂量甲泼尼龙+大剂量丙种球蛋白。分析环孢素A血药浓度与临床疗效及合并用药之间的关系。结果 18例环孢素A浓度值<83.15μmol·L-1,治疗有效率46%;23例浓度值在83.15～166.30μmol·L-1范围内,治疗有效率58%;14例浓度值在166.30～332.61μmol·L-1范围内,治疗有效率75%;合并用药情况复杂,对环孢素A浓度的影响结果亦复杂。结论再生障碍性贫血患者环孢素A最佳稳态治疗窗为166.30～332.61μmol·L-1。

Blood concentration monitoring of cyclosporine A in patients with aplastic anemia

Objective To evaluate the relationship between efficacy and cyclosporine A(CsA) whole blood valley concentration in patients with aplastic anemia.Methods 55 CsA whole blood samples in 33 patients with aplastic anemia were measured by means of fluorescence polarization immunoassay(FPIA).According to the treatment protocols,33 patients were devided into four groups.Group A received CsA+androgen+ hematopoitic growth factors,group B received CsA+androgen+hematopoitic growth factors+high-dose methylprednisolone,group C received CsA+ androgen + hematopoitic growth factors+antithymocyte globulin(ATG),and group D received CsA+androgen+hematopoitic growth factors+high-dose methylprednisolone+ high-dose gama globulin.Then the relationship between efficacy and CsA blood concentration was analyzed.Result 18 instances′ concentration values were less than 83.15 μmol·L-1,and the response rate was 46%.23 instances′ concentration values were in the range of 83.15-166.30 μmol·L-1,and the response rate was 58%.14 instances′ concentration values were in the range of 166.30-332.61 μmol·L-1,and the response rate was 75%.The consequence of drug combination was complex.Conclusion The curative effect was good when the concentration of CsA was in the range of 166.30-332.61 μmol·L-1.