摘要
目的环孢素A作为一种特异性较强的免疫抑制剂,是再生障碍性贫血无可替代的基础治疗药物。但较窄的治疗窗和较大的个体代谢差异致使儿童环孢素A的血药浓度调整更加困难。本文旨在观察联用盐酸小檗碱对再生障碍性贫血患儿环孢素A血药浓度的影响。方法观察26例环孢素浓度不达标的再生障碍性贫血患儿联合服用小檗碱前、后环孢素A的血药浓度肝、肾功能和血脂变化。分别计算环孢素A血药浓度达标率及提升达标率。并进行二者合用后的药学经济学评估。结果患儿服用盐酸小檗碱前、后的环孢素A稳态全血谷浓度(C0)之间差异有统计学意义(P<0.01)。服用小檗碱前C0平均浓度为(67.15±9.04)ng/ml,联合后的平均浓度为(130.67±20.12)ng/ml,平均血药浓度增加(63.5±18.64)ng/ml,达标率由原来的7.7%增加至84.6%。两组肝肾功能均在正常范围,且合用前后无明显变化,差异均无统计学意义(P>0.05)。调整后可节省费用3212~4321元人民币/年。结论合用盐酸小檗碱能够升高再生障碍性贫血患儿环孢素A血药浓度,减少环孢素A服用剂量,减轻经济负担,且无明显不良反应。
Objective Cyclosporine(CsA),as a highly specific immunosuppressive agent,is an basic therapy drug for aplastic anemia(AA).However,the narrow treatment window and large individual metabolic differences make it more difficult to adjust the blood concentration of CsA in children.The objective of this study was to observe the effect of berberine hydrochloride on the concentration of CsA in children with AA.Methods To observe the changes of blood concentration,liver and kidney functions and blood lipid of cyclosporine A in 26 patients with substandard cyclosporine concentration.The compliance rate and promotion rate of CsA were calculated respectively.The pharmaceutical economics evaluation with combination of two drugs was also carried out.Results There was a statistically significant difference in CsA homeostasis(C0)before and after berberine hydrochloride(P<0.01).The average concertration of C0 increased from(67.15±9.04)ng/ml before the combination to(130.67±20.12)ng/ml after the combination.The average serum concentration increased by(63.5±18.64)ng/ml,and the compliance rate increased from 7.7%to 84.6%.The liver and kidney functions of the two groups were in the normal range,and there was no significant change before and after combined use(P>0.05).After adjustment,it could save 3212~4321 yuan each year.Conclusion Combined use of berberine hydrochloride can increase the blood concentration of CsA in children with AA and reduce the dose of CsA and save economic burden and have no obvious adverse reactions.
作者
成晓玲
马洁
王晓玲
吴润晖
CHENG Xiao-ling;MA Jie;WANG Xiao-ling;WU Run-hui(Department of Pharmacy,Beijing Children’s Hospital,Capital Medical University,Beijing 100045,China;Hematology Oncology Center,Beijing Children’s Hospital,Capital Medical University,Beijing Key Laboratory of Pediatric Hematology Oncology,National Key Discipline of Pediatrics,Capital Medical University,Beijing 100045,China)
出处
《世界临床药物》
CAS
2019年第12期840-844,共5页
World Clinical Drug
基金
国家自然科学基金课题(81970111)
北京然科学基金课题(7192064)
北京市医院管理局儿科学科协同发展中心“儿科专项”(XTZD20180205)
国家科技重大专项(2017ZX09304029)。
关键词
盐酸小檗碱
再生障碍性贫血
儿童
环孢素A
血药浓度
berberine hydrochloride
aplastic anemia
children
cyclosporine A
blood concentration
