【作者】 邱蕾； 姜玲； 张善堂； 唐丽琴； 陈卫东；

【Author】 Qiu Lei;Jiang Ling;Zhang Shantang;Tang Liqin;Chen Weidong;Department of Pharmacy,Anhui Provincial Hospital;Anhui University of Traditional Chinese Medicine;

【机构】 安徽省立医院药剂科； 安徽中医药大学；

【摘要】 目的:基于国内外报道的关于异基因造血干细胞移植(allogeneic hematopoietic stem cell transplantation,Allo-HSCT)术后环孢素A (Cyclosporine A,CsA)监测的研究,评价谷浓度和峰浓度监测在预测Allo-HSCT术后发生移植物抗宿主病(graft-versus-host disease,GVHD)及不良反应(adverse reactions,ADR)的有效性。方法:计算机检索Medline数据库、The Cochrane Library、中国期刊全文数据库(CNKI)、万方数据库、中文科技期刊全文数据(VIP-维普)。收集国内外公开发表的相关研究,检索年限从建库到2013-12-31,按纳入排除标准筛选文献并评价纳入研究的质量后,采用RevMan 5.0软件进行Meta分析。结果:共纳入7篇文献,合计323例患者。Meta分析结果显示,CsA谷浓度监测GVHD的发生率低于峰浓度[RR=0.11,95%CI(0.03,0.33),P=0.0001]。Ⅰ-Ⅱ级与Ⅲ-Ⅳ级GVHD患者CsA谷浓度有显著性差异,[RR=23.44,95%CI(5.51,41.36),P=0.01]。CsA谷浓度<200μg/L与≥200μg/L,GVHD的发生率有显著性差异[RR=15.05,95%CI(1.83,123.7),P=0.01]。CsA谷浓度<400μg/L与CsA谷浓度≥400μg/L相比,ADR的发生率有显著性差异[RR=0.03,95%CI(0.00,0.17),P<0.0001]。结论:CsA谷浓度监测对预测异基因造血干细胞移植患者术后GVHD及ADR更有效。CsA谷浓度的治疗窗在200-400μg/L之间。更多还原

【Abstract】 Objective:Based on domestic and overseas reports,to evaluate the effect of cyclosporine C₀-level monitoring and C2-level monitoring on predicting graft-versus-host disease and adverse reactio ns in allogeneic hematopoietic stem cell transplantation recipients.Methods:Related published abroad s tudies were collected by searching the electronic bibliographic databases such as Medline Database、Th e Cochrane Library、CNKI、Wanfang and VIP from its building to 2013-12-31.All the relevant studi es were identified and the quality of the included studies was assessed.The RevMan 5.0 software was used for meta-analysis.Results:A total of seven studies involving 323 patients were included.Meta-an alysis showed that:the rate of graft-versus-host disease and adverse reactions in C₀ was lower than th at in C₂ [RR=0.11,95%CI（0.03,0.33）,P=0.0001].There was significant differences between C₀ of grade I and grade II-IVgraft-versus-host[RR=23.44,95%CI（5.51,41.36）,P=0.01].There was significant difference s between C₀<200 section and C₀≥200 section in the rate of graft-versus-host [RR=15.05,95%CI（1.83,123.7）,P=0.01].There was significant differences between C₀<400 section and C₀≥400 section in the rat e of adverse reactions [RR=0.03,95%CI（0.00,0.17）,P<0.0001].Conclusion:C₀ is a more accurate predi ctor of the occurrence of the graft-versus-host disease and adverse reactions than C₂ in allogeneic hem atopoietic stem cell transplantation recipients.The cyclosporine’s therapeutic window is between 200 an d 400 μg/L.更多还原