Sommerer Claudia, Giese Thomas, Meuer Stefan, Zeier Martin
Department of Nephrology, University Hospital, INF 162, Heidelberg, Germany.
Saudi J Kidney Dis Transpl. 2010 Nov;21(6):1030-7.
A maximum of efficacy with a minimum of toxicity is the ultimate goal of immunosuppressive therapy. Calcineurin inhibitors are widely used as immunosuppressive drugs, and there is still a discussion about the optimal blood levels of cyclosporine A (CsA) and tacrolimus (Tac), balancing safety and efficacy. Monitoring of calcineurin inhibitor therapy is usually performed by blood trough levels, pharmacokinetics such as measurement of two hour peak levels, or by various areas under the curve assessments (AUC, 4 to 12 hours). All these mentioned pharmacokinetic measurements cannot predict the individual biological effects of the immunosuppressive drug. Several approaches have been undertaken to measure immunosuppression by calcineurin inhibitors. In this manuscript, general and specific immune monitoring strategies of calcineurin inhibitors and their clinical benefits are discussed.
以最小的毒性实现最大的疗效是免疫抑制治疗的最终目标。钙调神经磷酸酶抑制剂作为免疫抑制药物被广泛使用，关于环孢素A（CsA）和他克莫司（Tac）的最佳血药浓度，在安全性和疗效之间的平衡仍存在讨论。钙调神经磷酸酶抑制剂治疗的监测通常通过血药谷浓度、药代动力学（如两小时峰值水平的测量）或各种曲线下面积评估（AUC，4至12小时）来进行。所有这些提及的药代动力学测量都无法预测免疫抑制药物的个体生物学效应。已经采取了几种方法来测量钙调神经磷酸酶抑制剂的免疫抑制作用。在本手稿中，讨论了钙调神经磷酸酶抑制剂的一般和特异性免疫监测策略及其临床益处。
