急性腹泻期间肾移植受者他克莫司血药浓度的变化

背景：长期以来器官移植工作者比较重视吗替麦考酚酯的肠道不良作用,而对他克莫司与腹泻的关系则未引起足够的关注。 目的：观察肾移植受者急性腹泻期间他克莫司的谷浓度变化及对腹泻的治疗效果。 方法：观察90例出现急性腹泻的肾移植受者,免疫抑制方案均为他克莫司+吗替麦考酚酯+泼尼松,检测围腹泻期间内他克莫司血药谷浓度及相关病原学指标,将浓度升高的72例患者中病原学检查阴性的48例患者分为2组,每组24例,一组在治疗过程中只减少他克莫司剂量,另一组同时减少他克莫司及吗替麦考酚酯剂量,观察对腹泻的治疗效果及他克莫司谷浓度升高持续时间。 结果与结论：两种方案对腹泻的治疗效果及他克莫司谷浓度升高持续时间差异均无显著性意义。腹泻是他克莫司浓度异常升高的重要因素,腹泻期间应适当减少他克莫司剂量及增加其血药浓度监测频率,以免增加他克莫司的不良反应;在治疗过程中没有必要同时减少吗替麦考酚酯剂量,以免增加排斥发应发生率。

Variation of tacrolimus trough levels in renal transplant recipients during acute diarrhea

BACKGROUND:For a long time, the organ transplant workers pay more attentions to the intestinal adverse effects of mycophenolate mofetil; however, the relationship between tacrolimus and diarrhea has not attracted much attention. OBJECTIVE:To observe the change of tacrolimus trough levels and treatment efficacy in renal transplant recipients during of acute diarrhea. METHODS:Ninety cases with acute diarrhea were observed after renal transplantation, tacrolimus+mycophnolate mofetil+prednisone triple immunosuppressive regimen was used to detect the tacrolimus rough levels and related etiological laboratory before, during and after acute diarrhea. Among 72 cases with increased tacrolimus trough levels, 48 cases with negative etiological examination were randomly divided into two groups: group A (n=24) and group B (n=24). The patients in group A only reduced the dose of tacrolimus in the course of the treatment and the patients in group B reduced the dose of tacrolimus and mycophnolate mofetil. We observed the efficacy and duration time of tacrolimus trough levels elevated. RESULTS AND CONCLUSION:There was no significant difference in the efficacy and the duration time of tacrolimus trough levels elevated between two groups. Diarrhea following kidney transplantation could significantly result in abnormally elevation of tacrolimus trough levels. We should reduce the dose of tacrolimus and increase the monitoring frequency of tacrolimus trough levels during diarrhea, which can reduce the incidence of adverse effects; in the course of the treatment, we should not to reduce the dose of mycophnolate mofetil, as it can increase the incidence of rejection rate.