摘要
目的探讨他克莫司(tacrolimus,Tac)个体内变异度(intra-patient variability,IPV)是否与肾移植受者慢性移植物失功密切相关。方法选取2009年1月至2016年12月在四川大学华西医院肾移植中心进行肾移植且在术后长期随访的肾移植受者共1167人,用移植后7~12月期间的Tac全血浓度计算得到Tac IPV。设定的结局(含终点)包括:(1)移植物衰竭,再移植,(再)开始透析,或肾小球滤过率(glomerular filtration rate,eGFR)≤15ml/min,活检证实的急性排斥反应(biopsy-proven acute rejection,BPAR);(2)组织学确定的移植肾小球病;(3)移植后12个月到最后一次随访期间,血清肌酐浓度加倍;(4)最后一次随访。分析不同IPV组肾移植受者肾脏功能差异,生存时间差异以及出现慢性移植物失功的情况。结果纳入研究的1167位患者中,有79(6.8%)位到达了移植物失功的终点。肾移植受者移植后7~12月Tac IPV平均值为25.7%;高IPV组移植后第15个月血清肌酐显著高于低IPV组(P<0.05),第15、21、24个月eGFR显著低于低IPV组(P<0.05)。多因素Cox回归分析结果显示:Tac IPV对肾移植预后的预测有一定作用,但并不显著(P=0.051,Harzards ratio:1.015,95%CI:1.000-1.031)。而受者的年龄、性别、移植后6h的移植物功能,是移植物存活的独立预测因子。结论高Tac IPV与肾移植受者移植物失功有一定临床相关性,同时高Tac IPV是预测肾移植受者移植后两年内肾脏功能的重要实验室指标。
Objective To investigate whether intra-patient variability(IPV)of tacrolimus(Tac)is closely related to chronic graft dysfunction in renal transplant recipients.Methods A total of 1167 renal transplant recipients were enrolled in this study.Their surgical operations were carried out during January 2009 and December 2016 in West China Hospital of Sichuan University.Tac IPV was obtained from whole blood during 7 and 12 months after transplantation.Set outcomes(including endpoints)include:(1)graft failure,retransplantation,(re)start dialysis,or glomerular filtration rate(eGFR)less than 15 ml/min,biopsy-proven acute rejection(BPAR);(2)histologically confirmed glomerulopathy;(3)12 months after transplantation to during the last follow-up period,serum creatinine concentration was doubled;(4)the last follow-up.The renal function,survival time and chronic graft failure of renal transplant recipients in different IPV groups were analyzed.Results Of the 1167 patients in this study,79(6.8%)reached the end point of graft failure.The mean value of Tac IPV in 7~12 months after transplantation was 25.7%.Serum creatinine was significantly higher in 15 months after transplantation in the high IPV group than in the low IPV group(P<0.05),and eGFR was significantly lower in the 15,21,24 months after transplantation in the high IPV group than in the low IPV group(P<0.05).Multivariate Cox regression analysis showed that Tac IPV had some effect on predicting the prognosis of renal transplantation,but it was not significant(P=0.051,Harzards ratio=1.015,95%CI:1.000-1.031).The recipients′age,sex and graft function at 6 months after transplantation were independent predictors of graft survival.Conclusion High Tac IPV is clinically associated with graft failure in renal transplant recipient and is an important medical indicator for predicting renal function in renal transplant recipients within two years after transplantation.
作者
马建军
陈瑶
李亚梅
白杨娟
邹远高
唐江涛
Ma Jianjun;Chen Yao;Li Yamei;Bai Yangjuan;Zou Yuangao;Tang Jiangtao(Department of Laboratory Medicine,West China Hospital of Sichuan University,Chengdu 610041,China)
出处
《中华临床实验室管理电子杂志》
2019年第3期156-161,共6页
Chinese Journal of Clinical Laboratory Management(Electronic Edition）
关键词
他克莫司
个体内变异
肾移植
Tacrolimus
Intra-patient variability
Renal transplantation
作者简介
通信作者:唐江涛,Email:tjtdr@hotmail.com
