术前肾移植受者给药后2小时环孢素水平的研究，用于预测术后最佳环孢素剂量。
Study of cyclosporine level at 2 hours after administration in preoperative kidney transplant recipients for prediction of postoperative optimal cyclosporine dose.
作者信息
Sukhavasharin Narin, Praditpornsilpa Kearkiat, Avihingsanon Yingyos, Kuoatawintu Pawinee, O-Charoen Ratchanee, Kansanabuch Talerngsak, Tungsanga Kriang, Eiam-Ong Somchai
机构信息
Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University Hospital.
出版信息
J Med Assoc Thai. 2006 Aug;89 Suppl 2:S15-20.
OBJECTIVE
Absorption profiling of cyclosporine is a current concept of drug monitoring. A single blood concentration measurement 2 hours after cyclosporine administration (C2) has been shown to be a good predictor of drug exposure and clinical outcome. The recommendation states that achieving the recommended target level of 1700 +/- 340 ng/ml within 3-5 days after renal transplantation is associated with a lower rate of acute rejection and nephrotoxicity. The high variation of pharmacokinetic profile and short limited time during early post-transplantation period make it hard to adjust the cyclosporine dose that can reach that target level on time. The present study was designed to be a method to predict the optimal pre-transplant CsA dose.
MATERIAL AND METHOD
Eleven living-related kidney transplant recipients were recruited to receive cyclosporine and were monitored for C2 concentration during the 2 weeks before operation by the designed method. The pre-transplant empirical dose of 3.5 mg/kg/dose every 12 hours were assigned to all patients. The first predicted dose was estimated by using C2 concentration of 1,700 ng/mL. The first predicted dose was prescribed to the patients. The second predicted dose was estimated by using C2 concentration of the first predicted dose. All patients received the average of the first and the second predicted doses of cyclosporine within 12-24 hrs before transplantation and until the 3rd day after transplantation.
RESULTS
Nine out of 11 patients (81.81%) reached the target C2 level on the 3rd day after transplantation without any serious side effect and complications. The most common side effect was nausea and a flushing sensation that usually abated with a later dose after transplantation.
CONCLUSION
The early postoperative optimal cyclosporine dose can be effectively predicted by pre-transplant C2 measurement as conducted in the present study.
目的
环孢素的吸收谱分析是当前药物监测的一个概念。环孢素给药后2小时的单次血药浓度测量值（C2）已被证明是药物暴露和临床结果的良好预测指标。该建议指出，肾移植后3 - 5天内达到推荐的目标水平1700±340 ng/ml与较低的急性排斥率和肾毒性相关。移植后早期药代动力学特征变化大且时间有限，使得难以按时调整能达到该目标水平的环孢素剂量。本研究旨在设计一种预测移植前环孢素最佳剂量的方法。
材料与方法
招募11名活体亲属肾移植受者接受环孢素治疗，并通过设计的方法在术前2周监测其C2浓度。所有患者均给予移植前经验性剂量，每12小时3.5 mg/kg/剂量。首次预测剂量通过使用1700 ng/mL的C2浓度估算得出，并给予患者。第二次预测剂量通过使用首次预测剂量的C2浓度估算得出。所有患者在移植前12 - 24小时内直至移植后第3天接受首次和第二次预测剂量的环孢素平均值。
结果
11名患者中有9名（81.81%）在移植后第3天达到目标C2水平，且无任何严重副作用和并发症。最常见的副作用是恶心和面部潮红，通常在移植后后续给药时减轻。
结论
如本研究中所进行的，通过移植前C2测量可以有效预测术后早期环孢素的最佳剂量。
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