摘要
背景:对使用环孢素A的患者进行长期、定期的血药浓度监测以做到个体化给药具有非常重要的临床意义。目的:总结肾移植后环孢素A血药浓度监测方法及影响其血药浓度的因素,以期为临床安全有效地使用环孢素A提供参考。方法:以"环孢素A、肾移植、血药浓度、影响因素"及"Cyclosporin A,Renal Transplantation,blood drug level"为关键词,采用计算机检索2000-01/2012-01相关文章。纳入肾移植后应用环孢素A进行免疫抑制治疗,并对其血药浓度进行检测的文章及有关环孢素A检测方法及影响环孢素A血药浓度因素的文章;排除重复研究或Meta分析类文章。共纳入30篇相关文献进行综述。结果与结论:由于环孢素A的治疗窗较窄,生物利用度相差较大,一般的给药方案是首次剂量依据体质量给予,此后则参考环孢素A的测定浓度及时进行剂量调整。目前主要采用荧光偏振免疫法及高效液相色谱法对其血药浓度进行检测,同时可应用人工神经网络对其进行预测。当然在调整给药剂量的同时还要考虑一些药物相互作用及患者自身病理生理因素的影响。肾移植后患者必须在其治疗过程中常规性监测环孢素A血药浓度,避免出现环孢素A血药浓度过大或不足,同时综合考虑临床各方面的因素,及时调整患者的用药情况,实施个体化用药方案,使肾移植后患者能获得最佳治疗效果。
BACKGROUND：It has an important clinical significance for the individual administration to perform the long-term and periodic blood drug level monitoring on the patients who use cyclosporin A.OBJECTIVE：To summary the methods to monitor the cyclosporin A blood drug level and the influencing factors in order to provide the reference for the clinical using of cyclosporin A safely and effectively.METHODS：A computer-based search was performed for the articles from January 2000 to January 2012 with the key words of ＂Cyclosporin A,Renal Transplantation,blood drug level＂.The articles relate to the immunosuppressive therapy by cyclosporin A after renal transplantation and the detection of the blood drug level,as well as the articles relate to the detection methods of cyclosporin A and the influencing factors of the cyclosporin A blood drug level were involved.The repetitive articles and the Meta analysis were eliminated and finally a total of 30 articles were included to review.RESULTS AND CONCLUSION：Due to the narrow therapeutic window and large bioavailability difference of cyclosporin A,the dose of cyclosporin A given in the first time was based on body mass in general,and the dose of the following administration was adjusted according to the concentration of cyclosporin A.The blood drug level was detected by fluorescence polarization immunoassay and high performance liquid chromatography,and predicted by artificial neural network at the same time.Drug interactions and the pathophysiological factors of the patients should be considered when adjust the dose of the administration.During the treatment after renal transplantation,the routine monitoring of the cyclosporin A blood drug level should be performed in order to maintain the blood drug level stability.Meanwhile,comprehensive consider the clinical factors,timely adjust the concentration of the administration and take the individual administration program in order to get the best treatment effect after renal transplantation.
出处
《中国组织工程研究》
CAS
CSCD
2012年第18期3387-3390,共4页
Chinese Journal of Tissue Engineering Research
