环孢素A血药浓度监测的临床意义

目的：探讨环孢素A(CsA)血药谷值浓度监测的临床意义。方法：对269例同种肾移植受者术后4081次CsA血药谷值浓度进行了分析。结果：随着移植肾存活时间的延长，CsA治疗浓度水平呈逐渐下降趋势。排斥反应发生时及排斥反应前两周内，CsA浓度不仅低下，而且有一持续约2周的显著下降过程，平均降幅达31％。术后一周内急性排斥反应的发生与CsA浓度关系不大。过高的CsA浓度则与肾中毒’反应有关。CsA治疗浓度与发生排斥反应时的浓度及肾中毒浓度均有一定程度的重叠。结论：认为术后CsA理想的治疗窗浓度应为：术后第1月内为300-450ng／ml，3月内为250～400ng／ml，半年内为200～350ng／ml，以后CsA浓度最好维持在150～250ng／ml。

Monitoring Cyclosporine Concentration in Renal Transplant Recipients

To assess the importhance of CsA blood level on renal graft outcome, acute rejection episodes and renal toxicity, atotal of 4081 posttransplant whole-blood CsA trough levels were assayed by means of HPLC in 269 renal transplant recipients on triple immunosuppression (CsA A2a Pre8d). The analysis shows acute rejection episodes were associated with the low blood levels of CsA. And more, there had a rapid decline(31%) of CsA level during 2 weeks before rejection episode. On the other hand, renal toxicity of CsA was associated with the high blood level of CsA. Theideal immunosuppressive CsA trough levels were found as follows: The whole blood CsA trough level was 300~450ng/ml within the first month after transplantation, 250~400ng/ml in three months, E00~350ng/mi in six months and 150~250ng/ml since then.