First Department of Medicine, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu-shi, Shizuoka, 431-3192, Japan.
Department of Laboratory Medicine, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan.
Sci Rep. 2022 Aug 9;12(1):13572. doi: 10.1038/s41598-022-17763-2.
Tacrolimus therapy for ulcerative colitis is ineffective in certain patients; these patients require biologics or colectomy. We examined the ability of serum albumin levels and leukocyte subtypes to predict the therapeutic efficacy of tacrolimus. Patients with ulcerative colitis treated with tacrolimus were divided into non-failure and failure (required colectomy or switch to biologics or systemic steroids) groups. Serum albumin levels and leukocyte subtypes at induction, week 1, and week 2 after reaching high trough levels were retrospectively examined. Tacrolimus therapy failed in 18/45 patients within 3 months. The week 2/week 1 albumin ratio was significantly different between the failure and non-failure groups (P < 0.001). The receiver operating characteristic curve analysis revealed optimal cut-off value of the week 2/week 1 albumin ratio was 1.06, and area under the curve was 0.815. Analysis of leukocyte subtypes revealed significant between-group difference in the week 1 lymphocyte to monocyte ratio (P < 0.001). Multivariate analysis showed week 2/week 1 albumin ratio ≤ 1.06 and week 1 lymphocyte to monocyte ratio ≤ 3.86. Therefore, a low week 2/week 1 albumin and low week 1 lymphocyte to monocyte ratio predicted failure within 3 months of tacrolimus induction; a combination of these markers could accurately predict failure.
他克莫司治疗溃疡性结肠炎在某些患者中无效；这些患者需要生物制剂或结肠切除术。我们研究了血清白蛋白水平和白细胞亚型预测他克莫司治疗效果的能力。将接受他克莫司治疗的溃疡性结肠炎患者分为非失败组和失败组（需要结肠切除术或转为生物制剂或全身类固醇治疗）。回顾性检查诱导时、达到高谷浓度后第 1 周和第 2 周的血清白蛋白水平和白细胞亚型。在 3 个月内，18/45 例患者的他克莫司治疗失败。失败组和非失败组的第 2 周/第 1 周白蛋白比值有显著差异（P<0.001）。受试者工作特征曲线分析显示，第 2 周/第 1 周白蛋白比值的最佳截断值为 1.06，曲线下面积为 0.815。分析白细胞亚型发现，第 1 周淋巴细胞与单核细胞比值在组间有显著差异（P<0.001）。多变量分析显示第 2 周/第 1 周白蛋白比值≤1.06 和第 1 周淋巴细胞与单核细胞比值≤3.86。因此，第 2 周/第 1 周白蛋白比值低和第 1 周淋巴细胞与单核细胞比值低可预测他克莫司诱导后 3 个月内的失败；这些标志物的组合可准确预测失败。
