肾移植中霉酚酸血浓度的监测

背景：作为抗代谢免疫抑制剂,霉酚酸酯以其低毒副作用的优点已经在实体器官移植中得到广泛应用。然而,临床上移植患者常联合用药,霉酚酸酯与其他免疫抑制剂（如环孢素A和他克莫司）联合使用时的药代动力学特点尚不清楚。目的：动态监测霉酚酸浓度,比较霉酚酸酯与不同免疫抑制剂联用时药代动力学特点,以探讨其最佳治疗浓度窗,指导临床个体化用药,从而提高疗效,降低其毒副反应。方法：应用SyvaEmit-2000药物浓度检测分析仪检测肾移植受者服药（霉酚酸酯）前（C0）、服药后0.5h（C0.5）和服药后2h（C2）霉酚酸血浓度,并根据3个时间点的浓度值来计算0-12h的霉酚酸血浆浓度-时间曲线下面积值。结果与结论：入选340例肾移植受者,共检测霉酚酸3点血浆浓度-时间曲线下面积820例次,霉酚酸酯＋他克莫司联合用药组574例次;霉酚酸酯＋环孢素A联合用药组246例次。霉酚酸酯与环孢素A联合应用时,0-12h的霉酚酸血浆浓度-时间曲线下面积值显著低于霉酚酸酯与他克莫司联合应用时,差异有显著性意义（P〈0.05）。霉酚酸酯联用他克莫司组服药前、服药后0.5h霉酚酸浓度值高于霉酚酸酯联用环孢素A组（P〈0.05）,霉酚酸酯联用环孢素A组服药后2h霉酚酸浓度值高于霉酚酸酯联用他克莫司组（P〈0.05）。霉酚酸酯联用他克莫司组服药后0.5h出峰的病例数高于霉酚酸酯联用环孢素A组（P〈0.05）。结果可见霉酚酸酯与不同免疫抑制剂联用时应根据相应的药代动力学特点给药,如与他克莫司联用时,应该更早地减低他克莫司剂量。三点霉酚酸血浆浓度-时间曲线下面积监测相对简便易行,在临床应用更具有可操作性。

Monitoring the blood concentration of mycophenolic acid in renal transplantation

BACKGROUND： As an immunosuppressant of anti-metabolites, mycophenolic acid has been widely used in organ transplantation due to its relatively low toxicity. However, its pharmacokinetic properties are unclear when combined with other immunosuppressants such as calcineurin inhibitors （tacrolimus or cyclosporine A）. OBJECTIVE： To explore the optimal concentration of mycophenolic acid by dynamically monitoring its concentration in renal transplantation recipients, comparing the pharmacokinetic properties of mycophenolic acid when combined with other immunosuppressants, in order to guide personalized medicine, thereby improving the therapeutic effect and reducing adverse effects. METHODS： The concentration of mycophenolic acid in the blood before drug administration （C0）, 0.5 hour after drug administration （C0.5）, and 2 hours after drug administration （C2） in the kidney recipients was determined using SyvaEmit-2000 drug concentration detection analyzer. RESULTS AND CONCLUSION： Total 820 mycophenolic acid area under the concentration time curve values were determined from 340 recipients, among which 574 mycophenolic acid area under the concentration time curve values were determined from the recipients received mycophenolate mofetil＋tacrolimus and 246 from the recipients received mycophenolate mofetil＋cyclosporine A respectively. In mycophenolate mofetil＋cyclosporine A, the value of mycophenolic acid area under the concentration time curve was significantly lower than that in the mycophenolate mofetil＋tacrolimus group, and the difference was significant （P 0.05）. The concentration of mycophenolic acid at C0 and C0.5 in the mycophenolate mofetil＋tacrolimus group was higher than that in the mycophenolate mofetil＋cyclosporine A group （P 0.05）, and concentration of mycophenolic acid at C2 in the mycophenolate mofetil＋cyclosporine A groupwas higher than that in the mycophenolate mofetil＋tacrolimus group （P 0.05）. Furthermore, in mycophenolate mofetil＋tacrolimus group, more patients reached their peak concentration of mycophenolic acid at C0.5 . The results indicated that when mycophenolate mofetil was used in combination with other immunosuppressants, the drug administration should be based on their pharmacokinetics properties and the patients might be given a lower dose of mycophenolate mofetil. Three-point mycophenolate mofetil area under the concentration-time curve method for monitoring mycophenolic acid blood concentration was simple and convenient, and could meet the needs for the clinical use.