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中华临床实验室管理电子杂志

中华临床实验室管理电子杂志 ›› 2018, Vol. 06 ›› Issue (04) : 212 -215. doi: 10.3877/cma.j.issn.2095-5820.2018.04.005

所属专题： 文献；

实验研究

霉酚酸浓度监测对肾移植受者移植后感染的预测价值初探
白杨娟1, 石运莹2, 邹远高1, 唐江涛1, 李亚梅1, 王兰兰1,†()   
  1. 1. 610041　成都，四川大学华西医院实验医学科
    2. 610041　成都，四川大学华西医院肾脏内科
  • 收稿日期:2018-08-02 出版日期:2018-11-28
  • 通信作者: 王兰兰

A pilot study on predictive value of mycophenolic acid concentration monitoring in postoperative infection of renal transplant recipients

Yangjuan Bai1, Yunying Shi2, Yuangao Zou1, Jiangtao Tang1, Yamei Li1, Lanlan Wang1,†()   

  1. 1. Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu 610041, China
    2. Department of nephrology, West China Hospital, Sichuan University, Chengdu 610041, China
  • Received:2018-08-02 Published:2018-11-28
  • Corresponding author: Lanlan Wang
  • About author:
    Corresponding author: Wang Lanlan, Email:
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白杨娟, 石运莹, 邹远高, 唐江涛, 李亚梅, 王兰兰. 霉酚酸浓度监测对肾移植受者移植后感染的预测价值初探[J]. 中华临床实验室管理电子杂志, 2018, 06(04): 212-215.

Yangjuan Bai, Yunying Shi, Yuangao Zou, Jiangtao Tang, Yamei Li, Lanlan Wang. A pilot study on predictive value of mycophenolic acid concentration monitoring in postoperative infection of renal transplant recipients[J]. Chinese Journal of Clinical Laboratory Management(Electronic Edition), 2018, 06(04): 212-215.

目的

研究霉酚酸(mycophenolic acid，MPA)浓度监测对肾移植受者移植后感染的预测价值。

方法

纳入四川大学华西医院临床诊断为感染的住院肾移植受者48例(感染组)、一般情况稳定且排除感染的肾移植受者68例(对照组)，收集所有受者入院前、入院时及出院时服药前、服药后0.5 h、2 h、4 h MPA药物浓度(MPA-C0、MPA-C0.5、MPA-C2、MPA-C4)和简化药时曲线下面积(MPA Area Under Curve0-4，MPA-AUC0-4)、他克莫司(Tacrolimus，TAC)谷浓度(TAC-C0)、相关实验室检查、影像学等辅助检查等资料。

结果

感染组肾移植受者TAC-C0在入院前后基本稳定，均接近稳定组水平(P>0.05)。入院前，感染组肾移植受者MPA-AUC0-4及MPA-C4显著高于对照组(P<0.05)，MPA-C0和MPA-C2稍高于与对照组(P>0.05)；入院时，除MPA-C0明显低于对照组(P<0.05)，MPA-C2、 MPA-C4及MPA-AUC0-4在感染组稍低于对照组(P>0.05)；出院时，感染组MPA各时点浓度和MPA-AUC0-4均与对照组无显著差异(P>0.05)。

结论

MPA-AUC0-4、MPA-C4对肾移植受者感染发生有早期预示作用，霉酚酸治疗药物浓度监测有助于肾移植受者感染的预防控制。

关键词: 霉酚酸, 治疗药物浓度监测, 感染, 肾移植
Objective

To investigate the predictive value of mycophenolic acid (MPA) concentration monitoring in postoperative infection on renal transplant recipients.

Methods

Forty-eight hospitalized renal transplant recipients (infection group) and 68 non-infected renal transplant recipients (control group) were enrolled in West China Hospital of Sichuan University. MPA concentration including plasma MPA concentration before dose (MPA-C0), plasma MPA concentration 0.5 h after dose (MPA-C0.5), plasma MPA concentration 2 h after dose (MPA-C2), plasma MPA concentration 4 h after dose (MPA-C4), the simplified MPA AUC (MPA-AUC0-4) and the pre-dose blood concentration of Tacrolimus (TAC-C0), relevant laboratory data, imaging and other auxiliary examination data were analyzed.

Results

In the infected group, the TAC-C0 of the renal transplant recipients was basically stable before and after admission, all near the stability level (P>0.05). Before admission, MPA-AUC0-4 and MPA-C4 of renal transplant recipients in the infected group were significantly higher than those in the control group (P<0.05), MPA-C0 and MPA-C2 were slightly higher than those in the control group (P>0.05), MPA-C2, MPA-C4 and MPA-AUC0-4 were slightly lower than those in the infected group (P>0.05), except for MPA-C0. There was no significant difference in concentration and MPA-AUC0-4 between the control group and the control group (P>0.05). Conclusion MPA-AUC0-4 and MPA-C4 have early predictive significance for the occurrence of infection in renal transplant recipients. The monitoring of mycophenolic acid concentration is helpful for the prevention and control of infection in renal transplant recipients.

Conclusion

MPA-C4 and MPA-AUC0-4 possess an early predictive value for infection of renal transplant recipients.. Monitoring MPA concentration is helpful for prevention and control of infection in renal transplant recipients.

Key words: Mycophenolic acid, Therapeutic monitoring, Infection, Renal transplantation
表1 感染组与对照组肾移植受者基本情况分析
? 感染组(n=48) 对照组(n=68) P值
男:女 36:12 49:19 -
平均年龄(岁) 40.32±9.28 38.81±10.90 0.325
移植后时间(月) 32.50(12.00-68.00) 30.50(10.00-71.00) 0.821
RBC(×1012/mL) 4.14±0.80 4.64±0.75 0.001
HGB(g/L) 116.32±20.89 133.09±20.81 <0.01
HCT(L/L) 0.38±0.06 0.43±0.07 <0.01
CREA(mmol/L) 152.50±68.20 100.64±19.87 <0.01
BUN(mmol/L) 7.32±2.63 6.24±1.74 0.080
eGFR(ml/min) 60.21±21.82 79.21±18.15 0.031
AST(U/L) 20.50(16.32，26.57) 20.86(16.77，23.21) 0.302
ALT(U/L) 23.00(14.00-47.00) 22.00(13.00-45.00) 0.510
GGT(U/L) 27(17.75，63) 24.50(17.54，29.25) 0.312
表2 感染组和稳定组肾移植受者药物浓度和AUC分析
? TAC-C0(ng/ml) MPA-C0(ng/ml) MPA-C0.5(ng/ml) MPA-C2(ng/ml) MPA-C4(ng/ml) MPA-AUC0-4(mg·ml-1·min)
感染组 ? ? ? ? ? ?
? 入院前 5.65±1.94 3.73±1.86 17.65±10.04 7.90±3.66 5.67±2.78* 72.45±19.48*
? 入院时 5.83±2.72 2.39±1.48* 17.20±10.42 6.03±2.24 3.45±1.32 59.51±19.69
? 出院时 5.80±2.30 3.18±1.38 16.80±6.37 7.11±2.34 3.80±2.03 60.62±16.18
对照组 5.39±1.81 3.43±1.68 17.82±6.98 7.29±1.99 3.86±1.57 61.85±12.89
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