Tolou-Ghamari Zahra, Mortazavi Mojgan, Palizban Abbas-Ali, Najafi Mohammad-Reza
Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
Isfahan Kidney Diseases Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
Adv Biomed Res. 2015 Feb 23;4:59. doi: 10.4103/2277-9175.151876. eCollection 2015.
Neurotoxicity side effects related to cyclosporine kinetics could lead to dysfunction of kidney graft and patient outcome after transplantation. The aim of this study was evidence-based pharmacotherapy of kidney transplant recipients and to investigate neurotoxic levels of Iminoral.
The results of 2239 cyclosporine trough levels obtained from 743 patients were studied. Seventy-five adult kidney recipients who received Iminoral were studied for neurotoxicity symptoms. Demographic, clinical, hematology and biochemical data were recorded in d-base and analyzed using SPSS application for windows.
The mean value related to cyclosporine C0 was 246.3 μg/l. In the 48% the signs of neurotoxicity such as tremor and headache were noted, but only in 9% the levels of cyclosporine C0 were >400 μg/l. Further studies on 75 patients showed that the incidence of neurotoxic side effects were as follows: Tremor in 35, headache in 24 and anxiety in 34 recipients of kidney. The prescribed drug regimens from the day of transplant in most patients were based on mycophenolic acid or cellcept, pulse therapy using methylprednisolone (daily from kidney transplant up to 3 days after transplant), cyclosporine or Iminoral plus other drugs related to each individual. Administrations of ganciclovir, thymoglobulin, clotrimazol and prednisolone were also distinguished with immunosuppressant-based therapy simultaneously.
Evidence-based study related to pharmacotherapy of Iminoral showed that clinical presentation related to neurotoxic side effects such as tremor, headache and anxiety might be due to many factors such as polypharmacy. Planning immunosuppression to individual patients based on programmed therapeutic Iminoral monitoring, avoiding polypharmacy in terms of removal or drug minimization and focusing on first week after transplant seem to be a realistic option.
与环孢素动力学相关的神经毒性副作用可能导致肾移植功能障碍及移植后患者的预后。本研究的目的是对肾移植受者进行循证药物治疗，并研究山地明的神经毒性水平。
研究了743例患者的2239次环孢素谷浓度结果。对75例接受山地明的成年肾移植受者的神经毒性症状进行了研究。人口统计学、临床、血液学和生化数据记录在数据库中，并使用Windows版SPSS应用程序进行分析。
环孢素C0的平均值为246.3μg/l。48%的患者出现了震颤和头痛等神经毒性体征，但只有9%的患者环孢素C0水平>400μg/l。对75例患者的进一步研究表明，神经毒性副作用的发生率如下：35例患者出现震颤，24例患者出现头痛，34例肾移植受者出现焦虑。大多数患者从移植当天开始使用的药物方案基于霉酚酸或骁悉，使用甲泼尼龙进行脉冲治疗（从肾移植当天至移植后3天每日使用），环孢素或山地明加其他针对个体的药物。同时，更昔洛韦、抗胸腺细胞球蛋白、克霉唑和泼尼松龙的使用也与基于免疫抑制剂的治疗有所区别。
关于山地明药物治疗的循证研究表明，震颤、头痛和焦虑等与神经毒性副作用相关的临床表现可能是由多种因素引起的，如联合用药。根据程序化的山地明治疗监测为个体患者制定免疫抑制方案，在去除药物或尽量减少药物使用方面避免联合用药，并关注移植后的第一周，似乎是一个现实的选择。
