Department of Clinical Biochemistry and Molecular Pathology, Medical and Health Science Center, University of Debrecen, Debrecen, Hungary.
Clin Chem Lab Med. 2011 Nov;49(11):1849-53. doi: 10.1515/CCLM.2011.678. Epub 2011 Aug 18.
Mycophenolic acid (MPA), a selective inhibitor of lymphocyte proliferation, has lately been used to improve renal function and prolong graft survival in renal transplanted patients. Still, there is no consensus considering the recommended dosing and the therapeutic range of MPA.
To estimate the safe therapeutic range of MPA, its plasma level and indicators of kidney function were measured in 216 patients (138 male, 78 female, age 46 ± 12 years) 67 ± 46 months after transplantation. Besides MPA, patients received cyclosporine (Group A, n=122) or tacrolimus (Group B, n=77). Seventeen patients (Group C) were treated with MPA in combination with everolimus or sirolimus. Plasma MPA was measured by enzyme inhibition assay.
In the whole study group MPA level increased with the dose of MPA (p=0.013). MPA level was below the therapeutic range in 40% (Group A) and 45% (Group B) of patients, respectively. MPA was 1.9 ± 1.56 mg/L in Group A, 2.4 ± 1.69 mg/L in Group B. In Group A MPA level increased and cyclosporine decreased with the progress of renal disease.
Increasing MPA/cyclosporine ratio at more severe stages of chronic kidney disease was tolerable for the patients and rejection could be avoided. Tubular damage detected by urinary N-acetyl-β-D-glucosaminidase did not correlate with the MPA level.
霉酚酸（MPA）是一种淋巴细胞增殖的选择性抑制剂，最近被用于改善肾移植患者的肾功能并延长移植物的存活时间。然而，对于 MPA 的推荐剂量和治疗范围仍未达成共识。
为了评估 MPA 的安全治疗范围，我们在 216 例（男 138 例，女 78 例，年龄 46±12 岁）肾移植后 67±46 个月的患者中测量了 MPA 的血浆水平及其肾功能指标。除了 MPA，患者还接受了环孢素（A 组，n=122）或他克莫司（B 组，n=77）治疗。17 例患者（C 组）接受 MPA 联合依维莫司或西罗莫司治疗。采用酶抑制法测定 MPA 血浆浓度。
在整个研究组中，MPA 水平随 MPA 剂量的增加而升高（p=0.013）。A 组和 B 组分别有 40%（n=49）和 45%（n=35）的患者 MPA 水平低于治疗范围。A 组和 B 组的 MPA 水平分别为 1.9±1.56mg/L 和 2.4±1.69mg/L。在 A 组中，随着慢性肾脏病的进展，MPA 水平增加而环孢素减少。
在慢性肾脏病更严重的阶段增加 MPA/环孢素的比值对患者是可以耐受的，且可以避免排斥反应。尿 N-乙酰-β-D-氨基葡萄糖苷酶检测到的肾小管损伤与 MPA 水平无关。
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