免疫抑制剂血药浓度与肾移植术后腹泻的关联性分析

目的 探讨免疫抑制剂霉酚酸酯（MMF）、他克莫司（FK506）血药浓度与肾移植术后腹泻之间的关系。方法 选取2015年8月至2017年8月在安徽医科大学第一附属医院行肾移植手术的146例受者，根据术后是否发生腹泻分为两组，未发生腹泻的患者为非腹泻组（83例）、发生腹泻且大于1次者为腹泻组（63例），测定受者的霉酚酸谷浓度（MPA-C₀）和FK506谷浓度（FK506-C₀），记录术后出现的腹泻情况，运用统计软件分析MPA-C₀和FK506-C₀与腹泻间的关系。结果 腹泻组与非腹泻组之间MPA-C₀差异无统计学意义（P>0.05），FK506-C₀差异有统计学意（P<0.001）；ROC曲线分析显示，FK506-C₀仅在术后1个月差异有统计学意义（曲线下面积0.607，P<0.05），FK506 C₀<11.15 ng/mL是术后1个月发生腹泻的截断值，敏感度51.90%，特异性63.60%；MPA-C₀与FK506-C₀对腹泻发生不存在交互作用（P>0.05）。结论 MPA-C₀与腹泻的发生没有关联性，而较高的FK506-C₀易导致肾移植术后腹泻，其中术后1个月FK506-C₀ <11.15 ng/mL是发生腹泻的的最佳截断值。

Association analysis of plasma concentration of immunosuppressants with occurrence of diarrhea in renal transplant recipients

Objective To explore the relationship between plasma concentration of mycophenolatemofetil (MMF) and tacrolimus (FK506) and diarrhea after renal transplantation. Methods The 146 patients, who underwent kidney transplantation inthe First Affiliated Hospital of Anhui Medical University from Aug 2015 to Aug 2017, were divided into two groups(diarrhea group and non-diarrhea group). By measuring the plasma concentration of MPA and FK506 in the recipients, the occurrence of diarrhea after medication was recorded. Statistical software was used to analyze the association between MPA-C₀ and FK506-C₀ and the occurrence of diarrhea. Results There were no significant differences between MPA-C₀ of two groups with orwithout diarrhea (P>0.05). However, it was observed that FK506-C₀ difference between the two group was statistically significant (P>0.05). According to ROC curve, the AUC of theROC curve of FK506-C₀ to diagnose the occurrence of diarrhea 1 month after transplantationwas 0.607(P<0.05). FK506-C₀ less than 11.15 ng/mL 1 month after surgery was the best cutoff for diarrhea with a sensitivity of 51.90% and a specificity of 63.60%. There was no synergistic interaction between MPA-C₀ and FK506-C₀ on the occurrence of diarrhea (P>0.05). Conclusion MPA-C₀ has no relationship with the occurrence of diarrhea. However, higher FK506-C₀ is more likely to cause diarrhea after renal transplantation, and FK506-C₀<11.15 ng/mL one month after operation is the best cutoff value for occurrence of diarrhea.