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目的:分析肾移植患者他克莫司(FK506)血药浓度的监测情况,探讨FK506血药浓度与肝肾功能及血细胞之间的关系,为临床的合理用药提供依据。方法:收集某院2011年9月-2013年9月118例肾移植患者FK506血药浓度的数据,及血药浓度测定当天的生化、血常规检测结果。根据FK506血药浓度分为6组(1μg·L-1≤Ⅰ组≤4μg·L-1,4μg·L-1<Ⅱ组≤7μg·L-1,7μg·L-1<Ⅲ组≤10μg·L-1,10μg·L-1<Ⅳ组≤12μg·L-1,12μg·L-1<Ⅴ组≤15μg·L-1,Ⅵ组>15μg·L-1),对6组中的肝肾功能及血常规指标进行统计分析。结果:肾移植术后患者的FK506血药谷浓度有78.40%在5~15μg·L-1,其中有68.33%在目标浓度范围内。不同浓度组间,肾功能指标UREA、CREA、eGFR及血常规中RBC、Hb、Hct和GLU均存在显著差异(P<0.01),Ⅵ组的eGFR明显低于其他组,而GLU明显高于其他组;肝功能组合中TP、ALB、GLB和AST、TBIL虽然存在统计学差异但并无明显临床意义。结论:该院肾移植术后患者的FK506血药谷浓度基本控制在5~15μg·L-1;FK506对肝功能影响较小,临床药师需提醒医师FK506血药浓度过高可能容易引起高血糖和肾毒性。
OBJECTIVE: To analyze the monitoring of plasma concentrations of tacrolimus (FK506) in renal transplant recipients and to explore the relationship between the plasma concentration of FK506 and liver and kidney function and blood cells so as to provide a basis for clinical rational drug use. Methods: The data of plasma concentrations of FK506 in 118 patients with renal transplantation from September 2011 to September 2013 in a hospital were collected, and the biochemical and blood test results of the same day were collected. According to the concentration of FK506 blood plasma, the rats were divided into 6 groups (1μg · L-1≤Ⅰgroup≤4μg · L-1,4μg · L-1≤Ⅱμg≤L-1,7μg · L-1≤Ⅲμg L-1, 10μg · L-1 <Ⅳ group ≤12μg · L-1, 12μg · L-1 <Ⅴ group ≤15μg · L-1, Ⅵ group> 15μg · L-1) Liver and kidney function and blood indicators for statistical analysis. Results: The concentration of FK506 in renal transplant recipients was 78.40% at 5 ~ 15μg · L-1, of which 68.33% was within the target concentration range. There were significant differences in the renal function indexes UREA, CREA, eGFR and RBC, Hb, Hct and GLU in different concentration groups (P <0.01), while the eGFR in group VI was significantly lower than that of other groups Group; There was no statistical significance of TP, ALB, GLB and AST, TBIL in liver function group, but no significant clinical significance. CONCLUSIONS: The concentration of FK506 in patients after renal transplantation is basically controlled at 5 ~ 15μg · L-1. FK506 has little effect on liver function. Clinical pharmacists need to remind their physicians that excessive blood concentration of FK506 may cause hyperglycemia And nephrotoxicity.