Winkler M, Ringe B, Baumann J, Loss M, Wonigeit K, Pichlmayr R
Klinik für Abdominal- und Transplantationschirurgie, Medizinische Hochschule, Hannover, Germany.
Clin Chem. 1994 Dec;40(12):2247-53.
By retrospective analysis of 13,000 blood samples obtained from 248 patients receiving FK 506 therapy, we compared the suitability of plasma with that of whole blood as the matrix for therapeutic drug monitoring of FK 506. The plasma concentrations did not correlate with the concentrations in whole blood (r = 0.56). In contrast to plasma samples (analyzed by enzyme immunoassay), FK 506 was detectable in all whole-blood samples (analyzed by enzyme immunoassay/microparticle enzyme immunoassay). The inter- and intraindividual variations of FK 506 measurements were greater in plasma than in whole blood. Moreover, plasma concentrations correlated only poorly with clinical events. There was a tendency to greater plasma concentrations being measured during episodes of toxicity, but no clear difference was evident between stable course and rejection. In whole-blood specimens, a correlation between reduced or increased FK 506 concentrations and rejection or toxicity, respectively, was observed. The discriminatory power of whole-blood values was greater for the differentiation between toxicity and stable course than between rejection and stable course. We therefore recommend whole blood rather than plasma as the matrix for therapeutic monitoring of FK 506 concentrations.
通过回顾性分析从248例接受FK 506治疗的患者中获取的13,000份血样，我们比较了血浆与全血作为FK 506治疗药物监测基质的适用性。血浆浓度与全血浓度不相关（r = 0.56）。与血浆样本（通过酶免疫测定法分析）不同，在所有全血样本中（通过酶免疫测定法/微粒酶免疫测定法分析）均能检测到FK 506。FK 506测量的个体间和个体内变异在血浆中比在全血中更大。此外，血浆浓度与临床事件的相关性很差。在毒性发作期间测得的血浆浓度有升高的趋势，但在病情稳定和排斥反应之间没有明显差异。在全血标本中，分别观察到FK 506浓度降低或升高与排斥反应或毒性之间的相关性。全血值对于区分毒性和病情稳定的判别能力比对区分排斥反应和病情稳定的判别能力更强。因此，我们推荐使用全血而非血浆作为监测FK 506浓度的治疗基质。
