Garraffo R
Unité de Pharmacocinétique Clinique, Hôpital Pasteur, Nice.
Therapie. 1992 Jul-Aug;47(4):327-34.
In transplantation, the advantage of therapeutical follow-up of immunosuppressive treatment involving cyclosporine is generally recognized, even though the ideal therapeutic index has as yet not been perfectly defined. Cyclosporine blood level determination is merely one factor among many others in therapeutical success, but if replaced in its context, can provide valuable and relevant information. A certain number of rules exist regarding the use, and pharmacological surveillance, of cyclosporine in all patients treated with this medicine. These rules take into consideration the patients immunological responsivity, the length of time since transplantation, the position of cyclosporine in immunosuppressive treatment, related pathologies and medicines. However, it is of special interest to consider a few points according to the nature of the indication. In kidney transplantation, and nephrotoxicity, determination of cyclosporine blood level will help differential diagnosis between an immunological origin (graft rejection) and an iatrogenic origin; in liver transplantation the consideration of metabolite determination, and study of metabolite ratio, will enable the gathering of information on performance status and toxicity hazards. In some cases, the necessity to administer intravenous cyclosporine, and the special weakness of some patients as in bone marrow transplantation, treatment surveillance patterns will be altered. Finally in spite of our lack of background information, the use of cyclosporine in autoimmune diseases has shown that principles of treatment and surveillance differed from one pathology to another, this being increased in some cases (juvenile diabetes), or occasional and even non-essential (psoriasis).
在移植领域，尽管环孢素免疫抑制治疗的理想治疗指数尚未完全明确，但这种治疗的随访优势已得到普遍认可。环孢素血药浓度测定只是治疗成功的众多因素之一，但结合具体情况来看，它能提供有价值且相关的信息。对于所有接受该药治疗的患者，在环孢素的使用及药理监测方面存在一些规则。这些规则考虑了患者的免疫反应性、移植后的时间长度、环孢素在免疫抑制治疗中的地位、相关病理情况及药物。然而，根据适应证的性质考虑一些要点尤为重要。在肾移植中，鉴于肾毒性，环孢素血药浓度测定有助于鉴别免疫源性（移植排斥）和医源性病因；在肝移植中，考虑代谢产物测定及代谢产物比例研究，将有助于收集关于肝功能状态和毒性风险的信息。在某些情况下，如骨髓移植中需要静脉输注环孢素以及一些患者特别虚弱时，治疗监测模式会有所改变。最后，尽管我们缺乏背景信息，但环孢素在自身免疫性疾病中的应用表明，不同病理情况下的治疗和监测原则各不相同，在某些病例（青少年糖尿病）中差异增大，而在其他病例（银屑病）中差异偶尔存在甚至并不重要。
