摘要
目的研究心脏死亡器官捐赠（DCD）供者的CYP3A5基因型对肝移植受者术后早期Tac起始用量的指导意义，为Tac的使用提供个体化方案。方法选择2010年3月至2013年3月接受DCD供肝移植，且与供者CYP3A5基因型不相同的受者36例，将受者分为实验组和对照组。两组受者术后均采用Tac＋吗替麦考酚酯＋泼尼松的三联免疫抑制方案，实验组受者根据供者CYP3A5基因型的不同调整Tac的起始用量，对照组受者按照传统方法经验给药。两组受者吗替麦考酚酯和泼尼松的使用无差别。结果术后7d，实验组受者的血Tac浓度为（7．47±1．83）μg／L，达目标血Tac浓度的受者占72．2％（13／18），对照组为（8．68±5．14）μg／L，达目标血Tac浓度的受者占38．9％（7／18），两组比较，差异有统计学意义（P〈O．05）。实验组需要调整Tac剂量的受者占22．2％，而对照组受者占55．6％，两组比较，差异有统计学意义（P〈0．05）。术后3个月内，实验组与对照组急性排斥反应发生率分别为22．2％（4／18）和27．8％（5／18），Tac不良反应发生率分别为11．1％（2／18）和22．2%（4／18），实验组均低于对照组，但差异均无统计学意义（P〉0．05）。结论根据DCD供者CYP3A5基因型的不同，可以科学调整Tac的初始剂量，使肝移植受者术后尽早达到目标血Tac浓度，减少排斥反应发生率和降低Tac不良反应，实现Tac的个体化用药。
Objective To investigate the effect of the genotypic analysis of donor from cardiac death donation on the initial dose of Tac for liver transplant recipients and provide individualized administration for the early use of Tac in liver transplantation patients. Method Thirty recipients with a different＂ genotype of CYP3A5 from cardiac death donors were collected from March 2010 to February 2013. The matched recipients were randomly divided into experiment group and control group. There was an adjustment of initial doses of Tac according to the donors＂ different CYP3A5 genotypes in experiment group but not in control group. Result In experiment and control groups, the average Tac blood concentrations at the 7th day after operation were （7. 47 ±1.83） and （8. 68 ± 5.14） ng/mL, and the percent of recipeints reaching the optimal Tac concentrations was 72. 2±and 38. 9%, respectively （P〈0. 05）. In experiment and control groups, 22. 2% and 55.6% recipients needed adjustments of Tac concentrations respectively （P±0. 05）. Conclusion Individualized adjustment of Tac initial doses of recipients according to cardiac death donors＂ different CYP3A5 genotypes was benefit for reaching optimal concentrations as soon as possible and could decrease the rate of rejection, and reduce the side effects of Tac.
出处
《中华器官移植杂志》
CAS
CSCD
北大核心
2013年第5期280-283,共4页
Chinese Journal of Organ Transplantation
基金
中央高校基本科研业务费专项资金（6107002
117019
114075）
武汉市科技攻关项目（201161038344-01）
卫生公益性行业科研专项（201002004）
