Department of Clinical Pharmacology, Princess Alexandra Hospital, Brisbane, QLD, Australia.
Clin Biochem. 2011 Jan;44(1):14-20. doi: 10.1016/j.clinbiochem.2010.06.012. Epub 2010 Jul 1.
Therapeutic drug monitoring of critical dose immunosuppressant drugs is established clinical practice and there are similar good reasons to monitor antiretrovirals. The aim of this article is to review the recent literature (last five years), with particular reference to the use of liquid chromatography-tandem mass spectrometry (LC-MS/MS). LC-MS/MS offers many potential advantages. The superior selectivity of LC-MS/MS over immunoassays for immunosuppressant drugs has been widely reported. Simultaneous measurement of a number of drugs can be performed. It is currently routine practice for the four major immunosuppressants (cyclosporin, tacrolimus, sirolimus and everolimus) to be simultaneously measured in whole blood. While up to 17 antiretroviral drugs have been simultaneously measured in plasma. The exquisite sensitivity of LC-MS/MS also provides the opportunity to measure these drugs in alternative matrices, such as dried blood spots, saliva, peripheral blood mononuclear cells and tissue. However, the clinical utility of measuring these classes of drugs in alternative matrices is still to be determined.
治疗药物监测对于关键剂量免疫抑制剂类药物而言是一种既定的临床实践，而监测抗逆转录病毒药物也有类似的充分理由。本文的目的是回顾最近五年的相关文献，特别参考了液相色谱-串联质谱（LC-MS/MS）的应用。LC-MS/MS 具有许多潜在优势。LC-MS/MS 对免疫抑制剂类药物的选择性优于免疫测定法，这一点已得到广泛报道。可以同时测量多种药物。目前，在全血中同时测量四种主要免疫抑制剂（环孢素、他克莫司、西罗莫司和依维莫司）已成为常规做法。同时，多达 17 种抗逆转录病毒药物已在血浆中同时测量。LC-MS/MS 的超高灵敏度还提供了在替代基质（如干血斑、唾液、外周血单核细胞和组织）中测量这些药物的机会。然而，在替代基质中测量这些药物类别是否具有临床实用性仍有待确定。
