肾移植术后环孢素A药浓度与肝中毒关系及监测

目的：了解肾移植术后抗免疫排斥剂环孢素A（CsA)导致肝中毒发生的机率，以及肝中毒的监测意义。方法：荧光偏振免疫法测CsA;Abbott-Aeroset生化仪测测肝功能；B型彩超观察移植肾的型态及血流情况。结果：CsA的谷浓度范围在200－400ng/ml均可能发生肝中毒，肾移植后1个月、3个月、6个月、9个月、12个月肝中毒发生率分别为66％、40％、20％、14％、10％。监测肝中毒的指标选用丙氨转移酶（ALT）、总胆红素（TBIL）、总胆汁酸（TBA）。结论：非线性动力学药物CsA作为抗免疫排斥剂用于肾移植术后易引起肝中毒。术后1－3个月发生肝中毒可达到40％－60％。CsA的治疗浓度与中毒浓度范围窄有交叉，因而很难确定中毒的临界浓度。使用CsA时应动脉监测肝功能，肝功能的生化指标以TBA的灵敏度为好。

Surveillance of cyclosporine A concentration and it''''s relationship with liver intoxication after operation for kidney transplantation

Objective To study the possibility of liver intoxication cause by anti-immunization reject agent cyclosporine A(CsA) after kidney transplantation operation and the implication of liver intoxication monitoring.Method Cyclosporine A was measured by fluorescent immunoassay,Liver function was measured by Abbott-Aeroset biochemical Meter.Kidney position and blood flow was observed by B-mode color ultrasound Result The liver intoxication will occurred when the CsA peak concentration reach 200 to 400 ng/ml,the possibility rate of liver intoxication were 66%,40%,20%,14%,and 10% respectively after 1 month,3 months,6 months 9 months and 12 months of kidney transplantation.The indicator for liver intoxication monitoring were ALT,TBIL,TBA.Conclusion No-linear dynamic drug CsA used as anti-immunization reject agent can induce liver intoxication after kidney transplantation,the occurrence rate were 40% to 60% one to three month after operation.Th erange of CsA therapy concentration is narrow which is crossed and within the range of toxicity,it's difficulty to set the limit value for prevention.The liver function monitoring should be conducted when CsA was used for treatment and TBA should be selected as one major indicator.