摘要
他克莫司是器官移植术后免疫抑制治疗的一线用药,具有大环内酯类化合物化学结构,在我国临床主要用于肝、肾、心、肺及骨髓移植治疗中的抗排斥反应。基于他克莫司的治疗窗窄、个体差异大和药物暴露影响因素多等特性,药品说明书、临床指南和文献研究普遍推荐临床应进行治疗药物监测。药物治疗是以患者为中心、临床为主导的多学科融合的技术工作,他克莫司药品说明书中的信息无法覆盖临床实践中的全部问题,临床指南、专家共识作为医疗文件的重要补充,有助于临床问题的解决和患者治疗获益。《实体器官移植他克莫司个体化治疗专家共识》(以下简称"本共识")起草专家组分析了2020年以前的他克莫司相关指南和专家共识54篇,认为有必要医药多学科合作,全面、系统、深入地阐释他克莫司在实体器官移植中的应用,既从临床角度提出亟需提供的技术支持和深度解决的治疗问题,又从药学药理角度明确应关注的药品治疗要素和药学服务的药师职责清单,从而加强他克莫司的合理使用,提高患者获益。本共识由临床医师和药师共同起草,正文包括前言、临床应用、药学监测和临床药师4个部分,涵盖肝、肾、心和肺等器官移植的免疫抑制治疗,包括临床治疗靶目标、血药浓度监测、基因多态性测定和药物相互作用等。临床药师的主动参与有助于他克莫司治疗的个体化应用,本共识根据我国多家器官移植中心的经验,为临床药师在器官移植中的药学服务提出建议,以期提高药学服务质量,优化他克莫司个体化治疗。
Tacrolimus has been accepted as the first-line drug of immunosuppressive therapy after solid organ transplantation,with the macrolide chemical structure,which is mainly used for prophylaxis of rejection in liver,kidney,heart,lung or bone marrow transplantation treatment. Based on the characteristics of narrow therapeutic window,large inter-and intra-individual variances, multiple influencing factors of drug exposure, drug monitoring is widely recommended for tacrolimus in drug instructions,clinical guidelines and literature. Drug therapy is a patient-centered and clinical-dominated multidisciplinary technical work. The information in tacrolimus drug instructions cannot cover all the issues in clinical practice. As important supplements to medical documents,clinical guidelines and expert consensus are conducive to solving clinical problems and benefiting patients. “Expert Consensus on Individual Treatment of Tacrolimusin Solid Organ Transplantation”( hereinafter referred to as“the consensus”) drafting expert group analyzed 54 tacrolimus-related guidelines and expert consensus before 2020, and concluded that it is necessary for medical multidisciplinary cooperation to comprehensively,systematically and in-depth explain the role of tacrolimus in solid organ transplantation. The expert group not only put forward urgently needed technical support and thoroughly resolved treatment issues from clinical perspective,but clarify the drug treatment elements of concern and the pharmacist responsibility list of pharmaceutical care from pharmacological perspective,so as to strengthen the rational use of tacrolimus and improve the benefits of patients. The consensus was jointly drafted by clinical clinicians and pharmacists.The main text includes four parts: preface,clinical application,drug monitoring and clinical pharmacists,covering immunosuppressive therapy for liver,kidney,heart and lung transplantation,including clinical therapeutic targets,plasma concentration monitoring,gene polymorphism determination and drug i
作者
陈文倩
张雷
张弋
孙丽莹
陈文慧
黄洁
王卓
王晓星
李沭
柳芳
廖中凯
王学彬
张相林
CHEN Wenqian;ZHANG Lei;ZHANG Yi;SUN Liying;CHEN Wenhui;HUANG Jie;WANG Zhuo;WANG Xiaoxing;LI Shu;LIU Fang;LIAO Zhongkai;WANG Xuebin;ZHANG Xianglin(Chinese Pharmacological Society,Beijing 100050,China;Dept.of Pharmacy,China-Japan Friendship Hospital,Beijing 100029,China;Dept.of Organ Transplantation,the First Affiliated Hospital of Naval Medical University/Shanghai Changhai Hospital,Shanghai 200433,China;Dept.of Pharmacy,Tianjin First Central Hospital,Tianjin 300192,China;Dept.of Liver Transplant Center,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China;Dept.of Lung Transplantation,China-Japan Friendship Hospital,Beijing 100029,China;Heart Failure Center,Fuwai Hospital,Chinese Academy of Medical Sciences,Beijing 100037,China;Dept.of Pharmacy,the First Affiliated Hospital of Naval Medical University/Shanghai Changhai Hospital,Shanghai 200433,China)
出处
《中国医院用药评价与分析》
2021年第12期1409-1424,共16页
Evaluation and Analysis of Drug-use in Hospitals of China
基金
国家自然科学基金面上项目(No.82173900)
上海申康医院发展中心《促进市级医院临床技能与临床创新能力三年行动计划(2020—2022年)》重大临床研究项目(No.SHDC2020CR4072)。
关键词
他克莫司
实体器官移植
个体化治疗
专家共识
多学科合作
Tacrolimus
Solid organ transplantation
Individualized treatment
Expert consensus
Multidisciplinary cooperation
