基于基因检测和血药浓度监测技术优化肝移植术后他克莫司个体化给药方案

他克莫司是广泛应用于临床的钙调神经磷酸酶类抑制剂，被作为肝移植术后预防和治疗急性排斥反应的一线药物。然而，在临床应用中，他克莫司表现出治疗窗口窄、药动学个体差异大等特点，移植后早期低浓度的他克莫司可能会诱发排斥反应；而高浓度的他克莫司可能会导致肾毒性和/或神经毒性，因此对于他克莫司药动学的影响因素进行深入研究至关重要。本文通过检索中国知网（CNKI）、维普、万方以及PubMed数据库，综述了临床上对患者实行基因检测和血药浓度监测的必要性，得出根据基因多态性进行给药以及寻找替代药时曲线下面积的最佳采样点策略可能将有助于临床医生对他克莫司的最佳起始剂量进行预测，进而帮助调整维持方案，且有望减少不良反应的发生。

Optimization of individualized tacrolimus dosing regimen after liver transplantation based on genetic testing and blood concentration monitoring techniques

Tacrolimus, a widely used clinical calcium-modulated neural phosphatase inhibitor, is used as a first-line agent for the prevention and treatment of acute rejection after liver transplantation. However, in clinical applications, tacrolimus exhibits a narrow therapeutic window and large individual differences in pharmacokinetics, and low concentrations of tacrolimus in the early post-transplant period may induce rejection; whereas high concentrations of tacrolimus may lead to nephrotoxicity and/or neurotoxicity, so in-depth studies on the factors influencing the pharmacokinetics of tacrolimus are essential. In this article, we reviewed the clinical need for genetic testing and blood concentration monitoring in patients by searching the Chinese Network of Knowledge (CNKI), Wipro, Wanfang, and PubMed databases, and concluded that dosing based on genetic polymorphisms and the strategy of finding the optimal sampling point of the area under the curve at the time of substitution may be helpful to clinicians in predicting the optimal starting dosage of tacrolimus, which can help in the adjustment of the maintenance regimen, and is expected to reduce the incidence of adverse effects.