摘要
背景:个体间药物代谢的差异性导致药物浓度的不稳定性仍困扰着很多肾移植受者。由此,个体化用药始终是移植后指导免疫抑制药物治疗的热点话题。目的:总结国内外近几年来的文献报道,对肾移植后主要的几类免疫抑制药物的基因组学与基因多态性的研究进展做简要综述。方法:检索2005年1月至2014年8月万方医学网及Pub Med数据库相关文献。英文检索词为:Renal transplantation;Immunosuppressantdrugs;Polymorphism;Individual treatment;中文检索词为"肾移植;免疫抑制剂;基因多态性;个体化治疗"。纳入与肾移植后免疫抑制药物基因组学与基因多态性相关文献50篇进行探讨。结果与结论:特异性免疫抑制剂的广泛应用使得肾移植后排斥反应发生率显著降低,极大提高了肾移植受者的存活率。但由于明确的药物毒副作用和明显的个体差异性,移植受者需要坚持定期规律监测血药浓度以保证药物浓度稳定的维持在治疗区间内。监测血药浓度在一定程度上有效的避免了肾移植后排斥反应和药物毒副作用的发生。药物代谢基因领域关于药物代谢基因与药物动力学和药效学之间的研究提供了深入个体化给药的可能,与监测血药浓度相配合,提高药物的使用效率的同时能够避免长期应用带来的药物毒副反应,进一步提高移植物的长期存活率。
BACKGROUND：Wide variation between individuals leads to instability of drug concentration that stil troubles transplant recipients. Therefore, individual therapy has always been a hot topic folowing transplantation. OBJECTIVE：To review the research progress in the genomics and gene polymorphism of the main categories of immunosuppressive drugs after kidney transplantation. METHODS：A computer-based search of Wanfang and PubMed databases was used to retrieve relevant articles published from January 2005 to August 2014. The keywords were “renal transplantation; immunosuppressant drugs; polymorphism; individual treatment” in Chinese and English, respectively. Finaly, 50 articles related to genomics and gene polymorphisms of immunosuppressive drugs after kidney transplantation were enroled in result analysis. RESULTS AND CONCLUSION： Immunosuppressant drugs have been widely used among renal transplant recipients to decrease post-renal transplantation rejection rate and greatly improve the survival rate of renal transplant recipients. Because of its certain side effects and wide variation between individuals, therapeutic drug monitoring should be employed routinely after transplantation to keep blood levels within the therapeutic range. This monitor system is effective to avoid post-renal transplantation rejections and drug side effects to a certain extent. Research on the relationship between pharmacokinetics and pharmacodynamics and genetic factors which combined with therapeutic drug monitoring provides possibility to give specific doses that wil improve efficacy while decrease side effects of immunosuppressive drugs, thereby further improving the long-term graft survival rate.
出处
《中国组织工程研究》
CAS
CSCD
2014年第46期7509-7514,共6页
Chinese Journal of Tissue Engineering Research
基金
首都临床特色应用研究(Z13110700220000)~~
