104例不同民族肾病综合征患者他克莫司血药浓度的影响因素分析

目的:探究不同民族肾病综合征(NS)患者中他克莫司(TAC)血药浓度的影响因素。方法:采用回顾性研究方法,收集2017年12月-2018年11月在新疆医科大学第一附属医院确诊为NS并符合纳入/排除标准的104例患者的临床信息,包括性别、年龄、民族、身高、体质量、实验室相关检测、合并用药及TAC给药剂量等,通过SPSS 22.0软件分析TAC血药浓度的影响因素,以及合用五酯胶囊对TAC稳态血药谷浓度(c^ssmin)和剂量的影响。结果:104例患者,共计394例次TAC血药浓度监测。以TAC标准化血药浓度为终点指标,汉族患者显著低于维吾尔族和哈萨克族患者(P=0.003);合用五酯胶囊患者高于不合用患者(P=0.056);合用钙离子拮抗药患者显著高于不合用患者(P=0.01),合用质子泵抑制剂患者显著低于不合用患者(P=0.01);红细胞比容正常患者显著低于异常患者(P=0.001),尿素氮正常患者显著低于异常患者(P<0.001)。合用五酯胶囊患者的TAC剂量显著低于不合用患者(P=0.001),二者TAC的c^ssmin无明显差异(P=0.29)。结论:对于NS患者,在使用TAC时应考虑民族、钙离子拮抗药、质子泵抑制剂、红细胞比容、尿素氮及五酯胶囊对TAC血药浓度的影响。

Analysis of Influential Factors of Tacrolimus Blood Concentration in 104 Patients with Nephrotic Syndrome of Different Nationalities

OBJECTIVE:To investigate the influential factors of tacrolimus(TAC)blood concentration in patients with nephrotic syndrome(NS)of different nationalities.METHODS:In retrospective study,clinical information of 104 patients who diagnosed as NS and met inclusion/exclusion criteria were collected from the First Affiliated Hospital of Xinjiang Medical University during Dec.2017 and Nov.2018,including gender,age,ethnicity,height,body weight,laboratory test items,combined drug use and TAC dosage.Influential factors for TAC blood concentration were analyzed by SPSS 22.0 software,and effects of combined use of Wuzhi capsule on steady-state blood trough concentration(c^ssmin )and dose of TAC were also analyzed.RESULTS:Among 104 patients,totally TAC blood concentration of 394 case times were monitored;using TAC standardized blood concentration as endpoint,Han nationality group was significantly lower than Uygur and Kazak nationality group(P=0.003);patients receiving combined use of Wuzhi capsule were significantly higher than those without combined use of Wuzhi capsule(P=0.056);the patients with combined use of calcium antagonists was significantly higher than the patients without calcium antagonists(P=0.01);the patients with combined use of proton pump inhibitors were significantly lower than those without combined proton pump inhibitors(P=0.01);patients with normal hematocrit were significantly lower than those with abnormal hematocrit(P=0.001);patients with normal urea nitrogen were significantly lower than those with abnormal urea nitrogen(P<0.001).The dose of TAC in patients receiving combined Wuzhi capsule were significantly lower than those without combined use of Wuzhi capsule(P=0.001),there was no significant difference in c^ssmin of TAC between them(P=0.29).CONCLUSIONS:For NS patients,the effects of ethnicity,calcium antagonists,proton pump inhibitors,hematocrit,urea nitrogen and Wuzhi capsules on TAC blood concentration should be considered when TAC is used.