抗结核治疗对肾移植患者钙调酶抑制剂血药浓度的影响

目的:探讨抗结核治疗对肾移植患者钙调酶抑制剂血药浓度的影响。方法:对2例肾移植前、后并发结核感染的患者在抗结核治疗过程中钙调酶抑制剂血药浓度的变化进行分析。患者术后常规进行环孢素A(CsA)或他克莫司(FK506)+吗替麦考酚酯(MMF)+泼尼松(Pred)三联免疫抑制治疗,单克隆抗体荧光免疫偏振法测定服抗结核药前、后各个时期全血中CsA(或FK506)浓度的变化。结果:利福平可明显降低CsA的血药浓度。该患者的CsA日剂量需增加为原来的3倍以上才可维持较理想的血药浓度;利福喷汀可降低FK506的浓度,但降幅不大。结论:对肾移植前、后并发结核感染的患者应严密监测钙调酶抑制剂浓度,同时注意抗结核药不良反应的发生。

Effect of Anti - tuberculosis Therapy on Plasma Concentration of Calcineurin Phosphatase Inhibitors in Renal Transplant Recipients

OBJECTIVE： To discuss the effect of anti - tuberculosis therapy on plasma concentration of calcineurin phos- phatase inhibitors in renal transplant recipients. METHODS： The change in plasma concentration of calcineurin phosphatase inhibitors in 2 renal transplant recipients who were complicated with tuberculosis infection before or after renal transplantation was analyzed. The patients were routinely treated with cyclosporine （CsA） or tacrolimus （FK506） ＋ mycophenolate mofetil （MMF） ＋ prednisolone （Pred） . Monoclone fluorescence polarization immunoassay （FPIA） was employed to determine the concentration of CsA or FK506 in different time point before and after administration of antituberculosis drugs. RESULTS：Plasma concentration of CsA was down - regulated significantly by Rifampicin, and the daily dose of CsA has to be increased to more than 3 times the previous concentration before meeting the target concentration. The concentration of FK506 was slightly down - regulated by rifapentine. CONCLUSION ： The concentration of CsA or FK506 and the adverse effect of antituberculotic drugs should be closely monitored for renal transplant recipients complicated with tuberculosis infection.