Moyer T P, Post G R, Sterioff S, Anderson C F
Section of Clinical Chemistry, Mayo Clinic, Rochester, MN 55905.
Mayo Clin Proc. 1988 Mar;63(3):241-7. doi: 10.1016/s0025-6196(12)65097-6.
Two immunosuppressive regimens-cyclosporine plus prednisone and azathioprine plus prednisone-were compared in 78 renal transplantation patients (39 in each treatment group) who were successfully managed for more than 15 months. In patients who received cyclosporine, the dosage was adjusted to achieve trough whole blood concentrations of 100 to 250 ng/ml measured by liquid chromatography. A greater number of haplotypes matched in the azathioprine-treated group than in the cyclosporine-treated group (P less than 0.026). Graft survival was similar in patients who received azathioprine (95%) and those given cyclosporine (94%). The azathioprine group had a higher mortality (7%) than the cyclosporine group (2%). In a comparison of the two treatment groups, no statistically significant difference was found in posttransplant renal function, based on either serum creatinine or iothalamate clearance. We conclude that renal toxicity due to cyclosporine can be minimized to statistical nonsignificance by using cyclosporine dosages that provide trough whole blood concentrations in the range of 150 to 250 ng/ml during the first 4 months of therapy and 80 to 200 ng/ml thereafter.
在78例成功接受治疗超过15个月的肾移植患者（每个治疗组39例）中，对两种免疫抑制方案——环孢素加泼尼松和硫唑嘌呤加泼尼松进行了比较。接受环孢素治疗的患者，通过液相色谱法调整剂量，以使谷全血浓度达到100至250纳克/毫升。硫唑嘌呤治疗组匹配的单倍型数量比环孢素治疗组多（P小于0.026）。接受硫唑嘌呤治疗的患者移植物存活率（95%）与接受环孢素治疗的患者（94%）相似。硫唑嘌呤组的死亡率（7%）高于环孢素组（2%）。在比较两个治疗组时，基于血清肌酐或碘他拉酸盐清除率，移植后肾功能未发现统计学上的显著差异。我们得出结论，通过在治疗的前4个月使用能使谷全血浓度在150至250纳克/毫升范围内、之后在80至200纳克/毫升范围内的环孢素剂量，可将环孢素引起的肾毒性降至统计学上无显著意义的水平。
