【摘要】 目的系统评价CYP3A5基因型与肾移植术后他克莫司(FK506)血药浓度的关系。方法计算机检索PubMed(1966.1~2013.7)、Scivers(e1823.1~2013.7)、he Cochrane Librar(y2013年第7期)、CNK(I1994.1~2013.7)、VIP(1989.1-2013.7)、CBM(1978.1~2013.7)及WanFang Data(1995.1~2013.7),查找关于CYP3A5基因型与肾移植术后他克莫司(FK506)血药浓度/剂量关系的文献。根据纳入与排除标准筛选文献、提取资料和评价质量后,采用RevMan 5.2软件进行Meta分析。结果共纳入12篇文献,包含956例对象。Meta分析结果显示:在肾移植术后7天[MD=54.61,95%CI(–67.67,–41.54),P<0.000 01]、1个月[MD=–74.84,95%CI(–83.39,–66.29),P<0.000 01]、3个月[MD=–96.09,95%CI(–107.55,–84.64),P<0.000 01]、6个月[MD=–107.30,95%CI(–125.65,–88.95),P<0.000 01]和1年[MD=–78.32,95%CI(–123.02,–33.61),P=0.000 6],携带CYP3A5*3/*3基因型患者的FK506血药浓度/剂量值明显较携带其他基因型患者高;而携带*1/*1患者的FK506血药浓度/剂量值较低。结论肾移植术后FK506血药浓度/剂量值与CYP3A5基因型相关。因此在肾移植术后应用FK506作为免疫抑制治疗时,有必要对患者进行CYP3A5基因型检测,以指导临床治疗。更多还原

【Abstract】 Objective To systematically review the correlation between CYP3A5 genotypes and blood levels of tacrolimus(FK506) in renal transplant recipients.Methods Such databases as PubMed(January 1966 to July 2013),Sciverse(January 1823 to July 2013),he Cochrane Library(Issue 7,2013),CNKI(January 1994 to July 2013),VIP(January 1989 to July 2013),CBM(January 1978 to July 2013) and WanFang Data(January 1995 to July 2013) were electronically searched for studies about the correlation between CYP3A5 genotypes and FK506(blood concentration/dose-respones relationship) in renal transplant recipients.According to the inclusion and exclusion criteria,literature was screened,data were extracted,and the methodological quality of included studies was also assessed.hen,meta-analysis was performed using RevMan 5.2 sotware.Results A total of 12 articles involving 956 patients were included.he results of meta-analysis showed that,ater renal transplantation,there was a high dose-adjusted concentration of CYP3A5 *3/*3 carriers on the 7thday(MD=54.61,95%CI –67.67 to –41.54,P<0.000 01),in the 1stmonth(MD=–74.84,95%CI –83.39 to –66.29,P<0.000 01),in the 3rdmonth(MD=–96.09,95%CI –107.55 to –84.64,P<0.000 01),in the 6thmonth(MD=–107.30,95%CI –125.65 to –88.95,P<0.000 01),and in the 1styear(MD=–78.32,95%CI –123.02 to –33.61,P=0.000 6).he dose-adjusted concentration of FK506 in CYP3A5 *3/*3 patients was higher than the other genotypes,while the doseadjusted concentration of FK506 in CYP3A5 *1/*1 patients was low.Conclusion he blood concentration as well as dose-respones relationship of FK506 are associated with CYP3A5 genotype in renal transplant recipients.We propose that patients with renal transplantation should receive CYP3A5 genotypes test to determine the use of FK506 as an immunosuppressant,so as to guide its clinical application.更多还原