Gilbert S C, Emmett M, Menter A, Silverman A, Klintmalm G
Baylor Psoriasis Center, Dallas, TX 75246.
J Am Acad Dermatol. 1989 Sep;21(3 Pt 1):470-4. doi: 10.1016/s0190-9622(89)70209-7.
With increasingly widespread use of cyclosporine for the treatment of psoriasis, it is imperative to identify reliable markers of cyclosporine-induced nephrotoxicity. Five patients with extensive psoriasis and no significant preexisting renal disease were treated with oral cyclosporine (average dosage, 5 mg/kg per day; average duration of treatment, 9 weeks). Changes in serum creatinine measurements made immediately before and at the end of treatment were compared with changes in glomerular filtration rate as determined by 125I-iothalamate clearance. During treatment, the average serum creatinine value only increased from 1.0 +/- 0.2 to 1.1 +/- 0.3 mg/dl (+/- standard deviation), whereas iothalamate-based estimates of glomerular infiltration rate decreased from 100 +/- 22 to 63 +/- 37 ml/min/1.73 m2 (p less than 0.02). Simultaneous 125I-iothalamate and 24-hour creatinine clearances were obtained in two patients at the end of treatment and at 2 weeks after cyclosporine therapy. Glomerular filtration rates determined by iothalamate clearance were 14% to 30% lower than those calculated by 24-hour creatinine clearances. Neither serum creatinine measurements nor creatinine clearances (whether calculated or measured) accurately reflect the cyclosporine-induced decline in renal function as determined by glomerular filtration rate. In contrast, 125I-iothalamate clearance is a more accurate measurement of glomerular filtration rate, which provides a sensitive marker for monitoring potential cyclosporine-induced nephrotoxicity.
随着环孢素在银屑病治疗中的应用日益广泛，确定环孢素诱导的肾毒性的可靠标志物变得至关重要。五名患有广泛银屑病且无明显既往肾脏疾病的患者接受了口服环孢素治疗（平均剂量，每天5mg/kg；平均治疗持续时间，9周）。将治疗前和治疗结束时即刻测得的血清肌酐变化与通过1-碘-3-氨基-2,4,6-三碘苯甲酸清除率测定的肾小球滤过率变化进行比较。治疗期间，平均血清肌酐值仅从1.0±0.2mg/dl增加至1.1±0.3mg/dl（±标准差），而基于1-碘-3-氨基-2,4,6-三碘苯甲酸的肾小球滤过率估计值从100±22ml/min/1.73m²降至63±37ml/min/1.73m²（p<0.02）。在两名患者治疗结束时及环孢素治疗后2周同时获得了1-碘-3-氨基-2,4,6-三碘苯甲酸和24小时肌酐清除率。通过1-碘-3-氨基-2,4,6-三碘苯甲酸清除率测定的肾小球滤过率比通过24小时肌酐清除率计算的肾小球滤过率低14%至30%。血清肌酐测量值和肌酐清除率（无论是计算值还是测量值）均不能准确反映由肾小球滤过率确定的环孢素诱导的肾功能下降。相比之下，1-碘-3-氨基-2,4,6-三碘苯甲酸清除率是肾小球滤过率更准确的测量方法，它为监测潜在的环孢素诱导的肾毒性提供了一个敏感标志物。
