肾移植受者应用霉酚酸酯的合理治疗窗 - 南方医科大学学报.pdf

·1842 · doi 10.3969/j.issn. 1673-4254.2014.12.29 J South Med Univ, 2014, 34(12): 1842-1845 临床研究 肾移植受者应用霉酚酸酯的合理治疗窗肾移植受者应用霉酚酸酯的合理治疗窗 于立新，周敏捷，罗 敏 南方医科大学南方医院器官移植科，广东 广州 510515 摘要：目的确定肾脏移植受者应用霉酚酸酯（MMF）的合理治疗窗浓度。方法 选取110例肾移植受者分别于术后1月内、2~3 个月、4 个月应用酶放大免疫分析技术测定口服MMF（分两次服用，间隔12 h ）12 h 后全血谷浓度（即MPA-C0 ），并观察受者用 药期间急性排斥反应及药物毒副反应发生情况，对所有受者随访时间均为1年。结果 统计资料显示，术后急性排斥反应发生 率为13.64%（15/ 110），药物毒副反应发生率为32.73%（36/ 110），其中白细胞减少症12例，MMF 相关性腹泻10例，感染10例，肝 功能损害4 例。发生急性排斥反应受者予甲基强的松龙冲击治疗后均成功逆转，药物毒副反应受者经治疗和（或）调整MMF 剂 量后病情恢复，无死亡病例及移植肾摘除病例。通过ROC 曲线计算得出，MPA-C0 控制在1.40~2.80 mg/L 可较好避免肾移植术 后急性排斥反应并减少受者的药物毒副反应。结论 对肾移植术后服用MMF 的受者进行MPA-C0监测，对MMF 用量进行个体 化调整，有利于预防急性排斥反应和药物毒副反应发生，减少并发症，提高移植肾及受者的存活率。 关键词：肾移植；霉酚酸酯；谷浓度；治疗窗 Therapeutic window of mycophenolate mofetil for preventing acute graft rejection following renal transplantation YU Lixin, ZHOU Minjie, LUO Min Department of Organ Transplantation, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China Abstract: Objective To determine the optimal dose range (therapeutic window) of mycophenolate mofetil (MMF) for preventing acute graft rejection following renal transplantation. Methods The trough concentration of MMF (MPA-C0) at 12 h after oral administration of the drug (two doses daily given at an interval of 12 h) was monitored in 110 renal transplant recipients within a month, in 2-3 months, and over 4 months after the transplantation using EMIT method. The occurrence of acute graft rejection and drug toxicity were observed in all the patients during the one-year follow-up. Results The incidence of acute graft rejection after transplantation was 13.64% (15/110) in these patients. Drug toxicity and complications occurred in 32.73% (36/110) of the patients, including 12 cases with reduced white blood cell counts, 10 with MMF cid-associated diarrhea, 10 with infe