118例肾移植患者他克莫司血药谷浓度与肝肾功能及血常规指标的关系

目的:分析肾移植患者他克莫司(FK506)血药浓度的监测情况,探讨FK506血药浓度与肝肾功能及血细胞之间的关系,为临床的合理用药提供依据。方法:收集某院2011年9月-2013年9月118例肾移植患者FK506血药浓度的数据,及血药浓度测定当天的生化、血常规检测结果。根据FK506血药浓度分为6组(1μg·L^-1≤Ⅰ组≤4μg·L^-1,4μg·L^-1<Ⅱ组≤7μg·L^-1,7μg·L^-1<Ⅲ组≤10μg·L^-1,10μg·L^-1<Ⅳ组≤12μg·L^-1,12μg·L^-1<Ⅴ组≤15μg·L^-1,Ⅵ组>15μg·L^-1),对6组中的肝肾功能及血常规指标进行统计分析。结果:肾移植术后患者的FK506血药谷浓度有78.40%在5~15μg·L^-1,其中有68.33%在目标浓度范围内。不同浓度组间,肾功能指标UREA、CREA、eGFR及血常规中RBC、Hb、Hct和GLU均存在显著差异(P<0.01),Ⅵ组的eGFR明显低于其他组,而GLU明显高于其他组;肝功能组合中TP、ALB、GLB和AST、TBIL虽然存在统计学差异但并无明显临床意义。结论:该院肾移植术后患者的FK506血药谷浓度基本控制在5~15μg·L^-1;FK506对肝功能影响较小,临床药师需提醒医师FK506血药浓度过高可能容易引起高血糖和肾毒性。

Correlation of blood trough concentration of tacrolimus with results of hepatic functions,renal functions and routine blood test in 118 patients after renal transplantation

OBJECTIVE To analyze the blood trough concentration data of tacrolimus(FK506) after renal transplantation in First Affiliated Hospital of Sun Yat-sen University, and investigate the relationship between hepatic functions, renal functions, routine blood test and different blood concentrations of FK506, and provide a reference for rational use of FK506. METHODS A total of 118 kidney transplant recipients between September 2011 and September 2013 were enrolled in this study. According to the range of FK506 blood concentrations, patients were divided into six groups(1 μg·L^-1≤Ⅰ≤4 μg·L^-1, 4 μg·L^-1<Ⅱ≤7 μg·L^-1, 7 μg·L^-1<Ⅲ≤10 μg·L^-1, 10 μg·L^-1<Ⅳ≤12 μg·L^-1, 12 μg·L^-1<Ⅴ≤15 μg·L^-1, Ⅵ>15 μg·L^-1), and corresponding clinical parameters were recorded and analyzed. RESULTS In our hospital, blood trough concentrations of FK506 in range of 5-15 μg·L^-1 accounted for 78.40%, and the proportion within therapeutic window was 68.33%. There were significant differences among six groups in UREA, CREA, eGFR and RBC, Hb, Hct, GLU(P<0.01). The eGFR was significantly lower and plasma glucose levels higher in group VI than other groups(P<0.01). Liver function indicators such as AST, TBIL and TP, ALB, GLB were significantly different, but had no clinical significance. CONCLUSION The blood trough concentration of FK506 after renal transplantation mainly falls in the range of 5-15 μg·L^-1 in our hospital. FK506 has little effects on hepatic functions, and clinical pharmacist should remind the clinicians that higher concentration of FK506 is prone to induce diabetogenic effects and nephrotoxicity.