他克莫司浓度在移植患者全血、血浆与血细胞中的相关性研究
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篇名: 他克莫司浓度在移植患者全血、血浆与血细胞中的相关性研究
TITLE:
摘要: 目的:研究移植患者全血、血浆与血细胞中他克莫司浓度的相关性,并分析移植类型及年龄对三者间他克莫司浓度相关性的影响,为临床合理用药提供参考。方法:随机选取我院20例移植术后使用他克莫司抗排异治疗并进行血药浓度监测的患者,根据移植类型分为肾移植组和肺移植组(各10例),根据年龄分为20~40岁组、41~60岁组和61~80岁组(分别有4、9、7例)。收集患者血药浓度监测的残血,采用化学发光微粒子免疫分析法(CMIA)检测全血中他克莫司谷浓度,并采用超高效液相色谱-串联质谱(UPLC-MS/MS)法同时检测血浆及血细胞中他克莫司浓度。应用散点图矩阵和Spearman秩相关性分析全血与血浆、全血与血细胞、血浆与血细胞中他克莫司浓度的相关性,以及移植类型、年龄对三者间他克莫司浓度相关性的影响。结果:全血与血浆中他克莫司浓度相关性(r=0.623,P<0.01)略强于全血与血细胞中他克莫司浓度的相关性(r=0.591,P<0.01),血浆与血细胞中他克莫司浓度相关性相对较弱(r=0.497,P<0.05)。移植类型、年龄对全血、血浆、血细胞三者间他克莫司浓度相关性均有影响,肾移植组患者全血、血细胞、血浆三者间他克莫司浓度相关性均较弱(r均<0.5),且弱于肺移植组患者;20~40岁组患者全血、血浆、血细胞三者间他克莫司浓度相关性也均较弱(r均<0.3),且均弱于41~60岁组、61~80岁组患者。结论:移植术后患者全血、血浆与血细胞三者间他克莫司浓度的相关性均不强,尤其是肾移植患者和20~40岁年龄段患者,应加强对其排斥反应和不良反应的监测。
ABSTRACT: OBJECTIVE: To study the correlation of tacrolimus concentrations among transplant patients’ whole blood, plasma and blood cells, analyze the effects of transplant types and ages on the their correlation, and to provide reference for rational drug use in clinic. METHODS: Totally 20 patients receiving tacrolimus anti-rejection therapy after transplantation and undergoing therapeutic drug monitoring (TDM) were randomly selected. According to the type of transplantation, they were divided into renal transplantation group and lung transplantation group (10 cases for each group).  According to age, they were divided into three groups: 20-40 years old group, 41-60 years old group and 61-80 years old group (4, 9, 7 cases for each group). Their residual blood after TDM was collected. Chemiluminescence microparticle immuno assay  (CMIA) was used to detect the concentration of tacrolimus in whole blood. UPLC-MS/MS was used to measure the concentrations of tacrolimus in plasma and blood cells. Pairs plots and Spearman rank correlation analysis were used to analyze the correlation of tacrolimus between whole blood and plasma, between whole blood and blood cells, between plasma and blood cells as well as the effects of transplant types and ages on tacrolimus concentrations among tansplant patient’s whole blood, plasma and blood cells. RESULTS: The correlation of tacrolimus concentrations in whole blood and plasma (r=0.623,P<0.01) was slightly stronger than that of whole blood and blood cells (r=0.591, P<0.01); while  the correlation of tacrolimus concentration in plasma and blood cells was relatively weak (r=0.497,P<0.05). Transplant type and age had an effect on the correlation of tacrolimus concentrations among patients’ whole blood, plasma, blood cells. The correlation of tacrolimus concen- tration in whole blood, blood cells and plasma in renal transplantation group was also weak (all r<0.5), and was weaker than that in lung transplantation group. The correlation of tacrolimus concentration among whole blood, plasma and blood cells was weak in patients of aged 20-40 years old group (all r<0.3), and was weaker than that of patients of aged 41-60 years old group and 61-80 years old group. CONCLUSION: Post-transplantation patients’ tacrolimus concentrations in whole blood, plasma and blood cell have a weak correlation. Rejections and adverse effects should be monitored in these patients, especially those renal transplantation patients or those patients aged 20 to 40.
期刊: 2019年第30卷第15期
作者: 秦伟,王晓雪,张相林,陈文倩,杜雯雯,张丹,王晓星,刘慧芳,李沭,李朋梅
AUTHORS: QIN Wei,WANG Xiaoxue,ZHANG Xianglin,CHEN Wenqian,DU Wenwen,ZHANG Dan,WANG Xiaoxing,LIU Huifang,LI Shu,LI Pengmei
关键字: 他克莫司;肺移植;肾移植;全血;血浆;血细胞;超高效液相色谱-串联质谱法;治疗药物监测
KEYWORDS: Tacrolimus; Lung transplantation; Renal transplantation; Whole blood; Plasma; Blood cells; UPLC-MS/MS; Therapeutic drug monitoring
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