环孢素A治疗免疫相关性血细胞减少症血药浓度与疗效关系的研究

目的了解治疗免疫相关性血细胞减少症(IRP)过程中,环孢素A(CsA)血药浓度与疗效的关系。方法对2008年8月至2009年3月天津医科大学总医院血液科50例IRP患者CsA用药血药浓度及疗效进行分析。结果IRP患者空腹CsA血药浓度(C0)(141.3±97.0)μg/L;用药2 h后CsA血药浓度(C2)(437.2±241.9)μg/L。C2≥300μg/L的病例疗效、脱离血制品输注情况、髂骨骨髓增生情况均好于C2<300μg/L的病例。C0≥90μg/L患者的疗效、胸骨巨核数均好于C0<90μg/L的患者。应用CsA同时应用唑类抗真菌药物的病例血清尿素氮(BUN)升高的比例明显高于未用抗真菌药的患者。结论IRP患者CsA血药浓度与疗效相关,C2≥300μg/L及C0≥90μg/L疗效较好。CsA常规用量是安全的,并用唑类抗真菌药可引起肾损害。

Blood concentration and therapeutic efficacy of cyclosporine A in treatment of immuno-related pancytopenia:a correlation study.

Objective To investigate the correlation between blood concentration and efficacy of cyclosporine A(CsA) in treatment of immunorelated pancytopenia(IRP).Methods 50 IRP patients were recruited for analysis of correlation between blood concentrations and therapeutic efficacy of CsA.Results Among these IRP patients,the fasting blood concentration of CsA(C0) was(141.3±97.0)μg/L,which increased to(C2)(437.2±241.9)μg/L at 2 hours after medication with CsA.More patients with C2 ≥300 μg/L showed favorable therapeutic efficacy,discontinuation of blood-product transfusion,and ilium bone marrow hyperplasia than those with C2<300 μg/L.Patients with C0≥90 μg/L showed significantly better efficacy and sternal megakaryocyte counts than those with C0<90 μg/L.The level of blood urea nitrogen(BUN) in patients treated with concurrent CsA and azole antiungal agents was significantly higher than in those treated with CsA alone.Conclusion The blood concentration of cyclosporine is correlated with therapeutic efficacy in treatment of IRP.C2≥300 μg/L and C0≥90 μg/L of CsA were associated with a favorably better efficacy.Conventional dosage of CsA appears safe,while addition with azole antifungal agents may lead to kidney injury.