质子泵抑制剂对肾移植患者体内霉酚酸酯血药浓度的影响

 目的 本试验旨在考察我院肾移植患者术后早期应用质子泵抑制剂（PPIs）和后期停用PPIs后对霉酚酸酯(MMF)谷浓度的影响。方法 选择2009年～2010年在我院接受同种异体活体肾移植术的患者进行研究，所有患者均采用他克莫司（FK506）+霉酚酸酯（MMF）+泼尼松(Pred)的三联用药方案。利用HPLC法检测血浆霉酚酸（MPA）浓度，结合临床检验结果分析PPIs对MMF的影响。结果 术后早期服用PPIs的患者MPA谷浓度为（2.58±2.63）μg·mL-1，停用PPIs后MPA浓度为（1.98±1.57）μg·mL-1，二者无统计学差异。结论 移植早期应用PPIs不会降低MPA谷浓度，MMF固定剂量给药可使MPA浓度维持在目标浓度范围内。

Effects of proton pump inhibitors on mycophenolate trough concentration in renal transplant recipients

OBJECTIVE To explore the impact of PPIs therapy on mycophenolate mofetil（MMF） trough concentration in renal transplant recipients. METHODS Patients were enrolled after receiving de novo kidney transplantation in 2009-2010. The pharmacotherapy regimen was tacrolimus、mycophenolate mofiteil and prednisone. The concentration of mycophenolic acid in plasma was detected with HPLC. RESULTS The trough concentration of MPA in the patients using PPIs after kidney transplantation was 2.58±2.63μg·mL-1， and that in the patients after withdrawing PPIs was （1.98±1.57）μg·mL-1. There was no significance difference between these two groups. The clinical relevance between MPA trough concentration and creatinine or urea was minor. CONCLUSION Compared with the group without PPIs， PPIs therapy in combination with MMF does not appear to have a significant impact on early MPA trough concentration. The strategy of fixed dose of MMF can generate adequate concentration in patients whether or not receiving PPIs therapy.